Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11973 | TX |
NPI | 1255635900 |
---|---|
Provider Name | Dr. Allyson Jackson |
First Address | San Antonio, TX 78232-5052 |
Second Address | San Antonio, TX 78258-4546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 07/08/2013 |