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Individual
DR. BRANDON T. JACKSON
Active
Individual
DR. BRANDON T. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2011014558
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12014762
CAQH NUMBER
MO
Enumeration date
09/15/2009
Last updated
04/02/2022
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