Provider Demographics
NPI:1548604200
Name:JACKSON, FRANK KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:KENNETH
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DO
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 469
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0469
Mailing Address - Country:US
Mailing Address - Phone:509-473-6706
Mailing Address - Fax:509-473-6704
Practice Address - Street 1:711 S COWLEY ST STE 224
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1330
Practice Address - Country:US
Practice Address - Phone:509-473-6706
Practice Address - Fax:509-473-6704
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60742174208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program