Individual
JEFFREY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1294 SW 4TH AVE, ONTARIO, OR 97914-4567
(208) 414-2639
Mailing address
744 NW 1ST AVE, ONTARIO, OR 97914-2204
(208) 514-7624
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1251458524
—
Other
Enumeration date
05/08/2025
Last updated
05/09/2025
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