Provider Demographics
NPI:1235881814
Name:MARILYN JACKSON LLC
Entity Type:Organization
Organization Name:MARILYN JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:203-212-9284
Mailing Address - Street 1:10 SOUTH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4125
Mailing Address - Country:US
Mailing Address - Phone:203-212-9284
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST STE 205
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4125
Practice Address - Country:US
Practice Address - Phone:203-212-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service