Individual
JOHN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 N BUFFALO DR STE 202, LAS VEGAS, NV 89145-0397
(702) 527-7661
Mailing address
401 N BUFFALO DR STE 202, LAS VEGAS, NV 89145-0397
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
09/13/2011
Last updated
11/10/2011
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