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Individual
DR. MICHAEL WAYNE JACKSON
Active
Individual
DR. MICHAEL WAYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2004027940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208658
BLUE CROSS BLUE SHIELD
MO
01
—
5687508
FIRST HEALTH
MO
01
—
7483792
AETNA
MO
01
—
9422836
PHCS
MO
Enumeration date
12/28/2005
Last updated
07/08/2007
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