Individual
DR. BRYAN W JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., P.T.
Contact information
Practice address
410 SAYBROOK RD STE 100, MIDDLETOWN, CT 06457
(860) 638-3820
(860) 638-3840
Mailing address
410 SAYBROOK RD STE 100, MIDDLETOWN, CT 06457-4780
(860) 638-3820
(860) 638-3840
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3372
NC
225100000X
Physical Therapist
Primary
005803
CT
225100000X
Physical Therapist
9924
NC
Other
Enumeration date
08/04/2006
Last updated
05/03/2019
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