Provider Demographics
NPI:1225122500
Name:JACKSON, WILLIAM JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OXEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RALIEGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603
Mailing Address - Country:US
Mailing Address - Phone:919-329-7443
Mailing Address - Fax:919-662-1650
Practice Address - Street 1:260 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3943
Practice Address - Country:US
Practice Address - Phone:919-662-0044
Practice Address - Fax:919-662-1650
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085V1OtherBCBS
NC5902377Medicaid
NC2458225Medicare ID - Type Unspecified