Individual
DR. ALYCE F JACKSON
Active
Individual
DR. ALYCE F JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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