Individual
CHRISTOPHER THOMAS JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 BARNHILL DR, XE040, INDIANAPOLIS, IN 46202-5112
(317) 274-4455
(317) 278-4918
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01066357A
IN
2084N0400X
Neurology Physician
01066357
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01066357
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
01066357A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000654265
ANTHEM PTAN
IN
01
—
000001192083
ANTHEM PTAN
IN
05
—
200938620
—
IN
Enumeration date
05/14/2007
Last updated
03/11/2025
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