Provider Demographics
NPI:1285659615
Name:JACKSON, RODNEY GILKEY (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:GILKEY
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 1:309 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-2313
Mailing Address - Country:US
Mailing Address - Phone:503-842-6532
Mailing Address - Fax:503-842-6532
Practice Address - Street 1:309 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-2313
Practice Address - Country:US
Practice Address - Phone:503-842-6532
Practice Address - Fax:503-842-6532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGCZXMedicare ID - Type Unspecified