Individual
EBONY JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 N ARLINGTON AVE, INDIANAPOLIS, IN 46219-3223
(260) 508-6752
Mailing address
1011 N ARLINGTON AVE, INDIANAPOLIS, IN 46219-3223
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
03/13/2022
Last updated
06/07/2022
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