Individual
DR. MICHAEL WAYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
733 W KEARNEY ST, SPRINGFIELD, MO 65803-1229
(417) 831-7575
(417) 831-7632
Mailing address
733 W KEARNEY ST, SPRINGFIELD, MO 65803-1229
(417) 831-7575
(417) 831-7632
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2004027940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208658
BLUE CROSS BLUE SHIELD
MO
01
—
5687508
FIRST HEALTH
MO
01
—
7483792
AETNA
MO
01
—
9422836
PHCS
MO
Enumeration date
12/28/2005
Last updated
07/08/2007
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