Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12813 | FL |
N | 111NN1001X | Nutrition | 12813 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | 12813 | FL |
N | 111NX0100X | Occupational Health | 12813 | FL |
NPI | 1881259570 |
---|---|
Provider Name | Dr. Jeffrey Lamar Jackson II |
First Address | Miami, FL 33176-7221 |
Second Address | Miami, FL 33176-7221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |