Provider Demographics
NPI:1023447448
Name:JACKSON CHIROPRACTIC & REHABILITATION, LLC
Entity type:Organization
Organization Name:JACKSON CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:708-529-7111
Mailing Address - Street 1:3860 W 95TH ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2034
Mailing Address - Country:US
Mailing Address - Phone:708-529-7111
Mailing Address - Fax:866-403-6309
Practice Address - Street 1:3860 W 95TH ST
Practice Address - Street 2:UNIT 6
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2034
Practice Address - Country:US
Practice Address - Phone:708-529-7111
Practice Address - Fax:866-403-6309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHICC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty