Individual
DAVID EDWARD JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.M.T.
Contact information
Practice address
3321 E 35TH AVE, LAKE STATION, IN 46405-3016
(219) 714-4100
Mailing address
3321 E 35TH AVE, LAKE STATION, IN 46405-3016
(219) 714-4100
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
01/31/2008
Last updated
01/31/2008
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