Individual
DR. ALYCE F JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
375 N WALL ST STE P520, KANKAKEE, IL 60901-3493
(815) 932-6632
(815) 932-5760
Mailing address
375 N WALL ST STE P520, KANKAKEE, IL 60901-3493
(815) 932-6632
(815) 932-5760
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036095105
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36095105
—
IL
01
—
632039
BC GROUP ID#
IL
Enumeration date
09/20/2006
Last updated
03/22/2021
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