Individual
TREVOR BRANDON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
1631 MAIN ST COLUMBIA SC, COLUMBIA, SC 29223
(803) 310-2793
Mailing address
8117 SPRINGFLOWER ROAD, COLUMBIA, SC 29223
(254) 462-3790
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10033
SC
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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