Individual
DR. BRANDON T. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5551 WINGHAVEN BLVD STE 20, O FALLON, MO 63368-3618
(636) 614-0401
(636) 265-0014
Mailing address
5551 WINGHAVEN BLVD STE 20, O FALLON, MO 63368-3618
(636) 614-0401
(636) 265-0014
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2011014558
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12014762
CAQH NUMBER
MO
Enumeration date
09/15/2009
Last updated
04/02/2022
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