Provider Demographics
NPI:1568569390
Name:PATTERSON, JACKSON CRAIG (DC)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:CRAIG
Last Name:PATTERSON
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 1:1304 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2646
Mailing Address - Country:US
Mailing Address - Phone:478-987-7555
Mailing Address - Fax:478-988-4508
Practice Address - Street 1:1304 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2646
Practice Address - Country:US
Practice Address - Phone:478-987-7555
Practice Address - Fax:478-988-4508
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor