Individual
CHRISTOPHER ROBERT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1502 LIATRIS LN, NORTH POLE, AK 99705-5082
(907) 385-5733
Mailing address
1680 MIDLAND ST, NORTH POLE, AK 99705-5881
(907) 385-5733
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
523381
AK
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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