Individual
NATHAN W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1134 MAIN ST, OCONTO, WI 54153-1540
(920) 834-7034
(920) 834-2844
Mailing address
PO BOX 131, OCONTO, WI 54153-0131
(920) 834-7034
(920) 834-2844
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
230100-8172
MI
111N00000X
Chiropractor
Primary
3687-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144266436
—
MI
05
—
38929400
—
WI
Enumeration date
08/08/2006
Last updated
09/01/2021
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