Provider Demographics
NPI:1346338696
Name:JACKSON, KRISTI KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:KAY
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:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-0017
Mailing Address - Country:US
Mailing Address - Phone:989-743-3515
Mailing Address - Fax:
Practice Address - Street 1:227 N SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1437
Practice Address - Country:US
Practice Address - Phone:989-743-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB007405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G850200OtherBCBSM
MI350051626OtherRAILROAD MEDICARE
MI950G850200OtherBCBSM
MIU66013Medicare UPIN