Individual
MR. KARL DWIGHT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
39 NW LOUISIANA AVE, BEND, OR 97701-3310
(541) 330-0334
Mailing address
62610 WAUGH RD, BEND, OR 97701-9782
(541) 678-4667
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6399
OR
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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