Individual
ANTONIOUS DEWAYNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., F.N.P-C
Contact information
Practice address
2900 HIGHWAY 121 STE 120, BEDFORD, TX 76021-4033
(817) 921-3000
(817) 921-3001
Mailing address
PO BOX 627, HURST, TX 76053-0627
(817) 770-3565
(817) 921-3001
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
DC9074
TX
363LF0000X
Family Nurse Practitioner
Primary
AP133741
TX
Other
Enumeration date
05/29/2007
Last updated
04/12/2017
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