Provider Demographics
NPI:1194830240
Name:JACKSON, JAMIE E (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1032
Mailing Address - Country:US
Mailing Address - Phone:864-528-3830
Mailing Address - Fax:864-583-8358
Practice Address - Street 1:1410 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1032
Practice Address - Country:US
Practice Address - Phone:864-528-3830
Practice Address - Fax:864-583-8358
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA09540281Medicare ID - Type Unspecified