Provider Demographics
NPI:1881643187
Name:JACKSON, DANNY C (DC)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:C
Last Name:JACKSON
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 1:341 HANCOCK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3690
Mailing Address - Country:US
Mailing Address - Phone:615-452-7392
Mailing Address - Fax:615-451-4191
Practice Address - Street 1:341 HANCOCK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3690
Practice Address - Country:US
Practice Address - Phone:615-452-7392
Practice Address - Fax:615-451-4191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3116598OtherBLUE CROSS BLUE SHIELD
TN1881643187OtherNPI
TN3116598OtherBLUE CROSS BLUE SHIELD
TN1881643187OtherNPI