Antonious Dewayne Jackson
Rehabilitation Chiropractor Nurse Practitioner - Family Medicine
2900 Highway 121 Ste 120
Bedford
, Texas 76021-4033
Antonious Dewayne Jackson
Rehabilitation Chiropractor Nurse Practitioner - Family Medicine
2900 Highway 121 Ste 120
Bedford
, Texas 76021-4033
(817) 921-3001
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About
Features
Specialties
- Rehabilitation Chiropractor
- Nurse Practitioner - Family Medicine
Languages spoken
- English
Location
First Address
- Antonious Dewayne Jackson
- Po Box 627
- Hurst, TX
- Zip : 76053-0627
- Fax : (817) 921-3001
- Phone : (817) 770-3565
Second Address
- Antonious Dewayne Jackson
- 2900 Highway 121 Ste 120
- Bedford, TX
- Zip : 76021-4033
- Fax : (817) 921-3001
- Phone : (817) 921-3000
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Is Antonious Dewayne Jackson a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 111NR0400X | Rehabilitation Chiropractor | DC9074 | TX |
| Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP133741 | TX |
National Provider Identifier
| NPI | 1205037322 |
|---|---|
| Provider Name | Antonious Dewayne Jackson |
| First Address | Hurst, TX 76053-0627 |
| Second Address | Bedford, TX 76021-4033 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/05/2007 |
| Last Update Date | 12/04/2017 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.