Organization
WILLACOOCHEE CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PENNY T. JACKSON D,C. (CHIROPRACTOR)
(912) 381-0064
Entity
Organization
Contact information
Practice address
1161 HIGHWAY 135 S, SUITE 1, WILLACOOCHEE, GA 31650-7747
(912) 381-0064
Mailing address
PO BOX 1100, WILLACOOCHEE, GA 31650-1100
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR008305
GA
Other
Enumeration date
04/11/2008
Last updated
04/11/2008
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