Individual
DEWAYNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PERSONAL TRAINER
Contact information
Practice address
4500 S SAGINAW ST, FLINT, MI 48507-2676
(810) 265-7121
Mailing address
2446 GREEN PINE DR APT 5, BURTON, MI 48519-1185
(810) 391-6328
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
T192947
MI
Other
Enumeration date
11/07/2016
Last updated
11/07/2016
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