Individual
COREY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1805 N 110TH AVE, OMAHA, NE 68154-1607
(531) 777-3884
Mailing address
1805 N 110TH AVE, OMAHA, NE 68154-1607
(531) 777-3884
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
07/01/2025
Last updated
07/01/2025
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