Provider Demographics
NPI:1346423456
Name:JACKSON, ROBERT LOUIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:JACKSON
Suffix:JR
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 1:170 OAK RD
Mailing Address - Street 2:
Mailing Address - City:YORK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17370-9775
Mailing Address - Country:US
Mailing Address - Phone:717-443-6276
Mailing Address - Fax:
Practice Address - Street 1:10850 SUSQUEHANNA TRL S
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-8217
Practice Address - Country:US
Practice Address - Phone:717-227-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor