Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath |
NPI | 1417107947 |
---|---|
Provider Name | Dr. Christopher L Jackson |
First Address | St Petersburg, FL 33702-4313 |
Second Address | St Petersburg, FL 33702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2008 |
Last Update Date | 09/06/2018 |