# DR. BRYAN W JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1649288317
- **Gender:** Man
- **Credential:** D.C., P.T.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 3372 | NC | — |
| 225100000X | Physical Therapist | 005803 | CT | Yes |
| 225100000X | Physical Therapist | 9924 | NC | — |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 05/03/2019