Individual
JACKSON D DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9950 CALUMET AVE, MUNSTER, IN 46321-4028
(219) 934-2840
(219) 934-2841
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05014727A
IN
225100000X
Physical Therapist
070026760
IL
Other
Enumeration date
07/11/2022
Last updated
09/26/2022
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