Individual
MR. CHRIS G JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
6191 N STATE HIGHWAY 161 STE 650, IRVING, TX 75038-2250
(972) 812-3299
Mailing address
2715 COLUMBUS, GRAND PRAIRIE, TX 75054-5512
(682) 365-2442
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
209724
TX
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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