Provider Demographics
NPI:1760237879
Name:JACKSON, MARQUIS L (BS,DC)
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ROGERS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1738
Mailing Address - Country:US
Mailing Address - Phone:740-804-1779
Mailing Address - Fax:
Practice Address - Street 1:158 ROGERS PKWY
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1738
Practice Address - Country:US
Practice Address - Phone:740-804-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC05354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor