Individual
JACKSON SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
627 KENNETH ST, MOSCOW, ID 83843-3904
(208) 310-3255
Mailing address
627 KENNETH ST, MOSCOW, ID 83843-3904
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/09/2017
Last updated
04/09/2017
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