Provider Demographics
NPI:1548737497
Name:BROWN, JACKSON BATTERSON (DC)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:BATTERSON
Last Name:BROWN
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 1:705 E PRAIRIE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8640
Mailing Address - Country:US
Mailing Address - Phone:208-518-8297
Mailing Address - Fax:208-518-1191
Practice Address - Street 1:705 E PRAIRIE AVE STE B
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8640
Practice Address - Country:US
Practice Address - Phone:208-518-8297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor