Provider Demographics
NPI:1164669313
Name:JACKMAN, JACQUE L (CMT)
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:L
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 OMEGA LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2524
Mailing Address - Country:US
Mailing Address - Phone:303-549-3192
Mailing Address - Fax:
Practice Address - Street 1:676 OMEGA LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80124-2524
Practice Address - Country:US
Practice Address - Phone:303-549-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist