Provider Demographics
NPI:1831241892
Name:JACKSON, CURTIS ALLEN (ATC)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:ALLEN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12826 EMILINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138
Mailing Address - Country:US
Mailing Address - Phone:402-990-0611
Mailing Address - Fax:
Practice Address - Street 1:2725 S 144TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5243
Practice Address - Country:US
Practice Address - Phone:402-637-0800
Practice Address - Fax:402-637-0852
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2255A2300X
SD02432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer