Provider Demographics
NPI:1477881696
Name:JACKSON, TERESA DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DANIELLE
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 1:15 GUM CREEK LNDG
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-2743
Mailing Address - Country:US
Mailing Address - Phone:347-893-0213
Mailing Address - Fax:770-817-0832
Practice Address - Street 1:5304 PANOLA INDUSTRIAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4065
Practice Address - Country:US
Practice Address - Phone:404-445-5032
Practice Address - Fax:404-845-7834
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor