Provider Demographics
NPI:1285857680
Name:JACKSON, RONALD EVANS (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EVANS
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 1:715 HILL COUNTRY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5965
Mailing Address - Country:US
Mailing Address - Phone:830-896-9633
Mailing Address - Fax:830-896-9644
Practice Address - Street 1:715 HILL COUNTRY DR STE 5
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5965
Practice Address - Country:US
Practice Address - Phone:830-896-9633
Practice Address - Fax:830-896-9644
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601885OtherPROVIDER ID
TX601885OtherPROVIDER ID