Provider Demographics
NPI:1629556899
Name:JACKSON CLINIC OF CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:JACKSON CLINIC OF CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-896-9633
Mailing Address - Street 1:715 HILL COUNTRY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5965
Mailing Address - Country:US
Mailing Address - Phone:830-896-9633
Mailing Address - Fax:830-896-9644
Practice Address - Street 1:715 HILL COUNTRY DR STE 5
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5965
Practice Address - Country:US
Practice Address - Phone:830-896-9633
Practice Address - Fax:830-896-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty