Provider Demographics
NPI:1396547642
Name:JACKSON, CHRISTOPHER MICHAEL (PCC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CERRETTA ST APT 8
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1819
Mailing Address - Country:US
Mailing Address - Phone:914-426-4532
Mailing Address - Fax:
Practice Address - Street 1:44 CERRETTA ST APT 8
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-1819
Practice Address - Country:US
Practice Address - Phone:914-426-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009864864IOtherINTERNATIONAL COACHING FEDERATION