Individual
CALVIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E MAIN ST, STE 201, MONROE, WA 98272-1519
(360) 863-0642
(360) 794-7236
Mailing address
PO BOX 14072, MILL CREEK, WA 98082-2072
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60431582
WA
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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