Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC.4413 | OH |
N | 111NX0100X | Occupational Health | CHIR009010 | GA |
NPI | 1578818548 |
---|---|
Provider Name | Ashley Jackson |
First Address | Shaker Heights, OH 44120-8114 |
Second Address | Mayfield Heights, OH 44124-4192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 30/09/2014 |