Individual
EBONY CHISOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 LAURENCE AVE STE E, JACKSON, MI 49202-2980
(517) 750-4777
Mailing address
2926 WOODS CIRCLE DR APT 1, JACKSON, MI 49203-2282
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/09/2022
Last updated
03/09/2022
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