Individual
MR. MIKEL JAMES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1832 101ST AVE, OAKLAND, CA 94603-3304
(408) 799-1230
Mailing address
PO BOX 761, SAN LEANDRO, CA 94577-0435
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/26/2013
Last updated
12/26/2013
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