Individual
CHAD EDWIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
14110 SIX MILE CYPRESS PKWY, FORT MYERS, FL 33912-4314
(239) 479-6411
(239) 768-2032
Mailing address
618 SE 3RD ST, CAPE CORAL, FL 33990-1109
(239) 292-7669
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
AL2986
FL
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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