Provider Demographics
NPI:1457430795
Name:JACKSON CLINIC OF CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:JACKSON CLINIC OF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-475-8157
Mailing Address - Street 1:630 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2601
Mailing Address - Country:US
Mailing Address - Phone:336-475-8157
Mailing Address - Fax:336-475-8160
Practice Address - Street 1:630 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2601
Practice Address - Country:US
Practice Address - Phone:336-475-8157
Practice Address - Fax:336-475-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08520OtherBCBS PROVIDER #
NC1437160124OtherNPI TYPE 1 #
NC0961460001Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
NC08520OtherBCBS PROVIDER #