Individual
BRIAN JEFFREY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO, AT
Contact information
Practice address
1600 UNIVERSITY AVE W STE 10, SAINT PAUL, MN 55104-3898
(651) 646-7246
(651) 641-0726
Mailing address
1258 GALTIER ST, SAINT PAUL, MN 55117-4456
(651) 260-5993
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Enumeration date
01/03/2018
Last updated
01/03/2018
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