Individual
DR. JACKSON CHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-4679
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
69038
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710480892
—
CT
Enumeration date
03/14/2018
Last updated
07/03/2021
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