Individual
JOHN LEONARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 NEW CAMPUS DR, BROCKPORT, NY 14420-2997
(585) 395-5374
Mailing address
350 NEW CAMPUS DR, BROCKPORT, NY 14420-2997
(585) 395-5374
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000254
NY
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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