Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2266 | TX |
NPI | 1164541546 |
---|---|
Provider Name | Mr. James S. Jackwoski |
First Address | Dallas, TX 75225-5943 |
Second Address | Dallas, TX 75225-5943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |