Provider Demographics
NPI:1801057369
Name:JACKMAN, PAUL DERMOT (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DERMOT
Last Name:JACKMAN
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 1:657 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2960
Mailing Address - Country:US
Mailing Address - Phone:508-879-9458
Mailing Address - Fax:508-879-4053
Practice Address - Street 1:657 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2960
Practice Address - Country:US
Practice Address - Phone:508-879-9458
Practice Address - Fax:508-879-4053
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor