Provider Demographics
NPI:1568029288
Name:JACSKON, CARA (DC)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:
Last Name:JACSKON
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 1:629 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4284
Mailing Address - Country:US
Mailing Address - Phone:678-358-5602
Mailing Address - Fax:
Practice Address - Street 1:1720 PHOENIX BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5595
Practice Address - Country:US
Practice Address - Phone:678-358-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor