Provider Demographics
NPI:1821211210
Name:DR. REBECCA R. JACKSON LLC
Entity Type:Organization
Organization Name:DR. REBECCA R. JACKSON LLC
Other - Org Name:BUILD AND BALANCE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-785-4120
Mailing Address - Street 1:12203 ABERDEEN ST NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4719
Mailing Address - Country:US
Mailing Address - Phone:763-785-4120
Mailing Address - Fax:763-785-4172
Practice Address - Street 1:12203 ABERDEEN ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4719
Practice Address - Country:US
Practice Address - Phone:763-785-4120
Practice Address - Fax:763-785-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty