Provider Demographics
NPI:1740578970
Name:JACKSON, ERIK (LAC)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N LOCUST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4140
Mailing Address - Country:US
Mailing Address - Phone:940-441-5404
Mailing Address - Fax:
Practice Address - Street 1:524 N LOCUST ST
Practice Address - Street 2:SUITE J
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4140
Practice Address - Country:US
Practice Address - Phone:940-441-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist