Provider Demographics
NPI:1093800856
Name:J2 OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:J2 OSTEOPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-765-9500
Mailing Address - Street 1:485 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-1637
Mailing Address - Country:US
Mailing Address - Phone:304-765-9500
Mailing Address - Fax:304-765-9502
Practice Address - Street 1:485 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1637
Practice Address - Country:US
Practice Address - Phone:304-765-9500
Practice Address - Fax:304-765-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty