1255635900 NPI number — DR. ALLYSON JACKSON D.C.

Table of content: DR. ALLYSON JACKSON D.C. (NPI 1255635900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255635900 NPI number — DR. ALLYSON JACKSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
ALLYSON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255635900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-404-6050
Provider Business Mailing Address Fax Number:
866-313-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 LIBBLE MILL EAST BLVD
Provider Second Line Business Practice Location Address:
SUITE 166
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-404-6050
Provider Business Practice Location Address Fax Number:
866-313-3397
Provider Enumeration Date:
01/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  0104-557634 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0104-557634 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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