Individual
CHADWICK THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
205 CHAMPION WAY STE 9, GEORGETOWN, KY 40324-8862
(615) 516-5194
Mailing address
205 CHAMPION WAY STE 9, GEORGETOWN, KY 40324-8862
(615) 516-5194
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5563
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5563
LICENSE NUMBER
KY
Enumeration date
01/24/2018
Last updated
01/24/2018
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