Individual
JACKSON COLEMAN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7402 93RD ST, LUBBOCK, TX 79424-4940
(806) 853-4098
Mailing address
7402 93RD ST, LUBBOCK, TX 79424-4940
(806) 853-4098
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/11/2026
Last updated
02/11/2026
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