Provider Demographics
NPI:1912079641
Name:JACKSON, DAVID CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:JACKSON
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:PO BOX 5339
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6815
Mailing Address - Country:US
Mailing Address - Phone:970-385-8556
Mailing Address - Fax:970-385-8604
Practice Address - Street 1:484 TURNER DR
Practice Address - Street 2:BUILDING E, SUITE 103
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7992
Practice Address - Country:US
Practice Address - Phone:970-385-8556
Practice Address - Fax:970-385-8604
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4242111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46103Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
COU62759Medicare UPIN