Individual
BRANDY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
147 MAIN STREET, WAGENER, SC 29164-9442
(803) 564-6000
(803) 564-6011
Mailing address
PO BOX 125, WAGENER, SC 29164-0125
(803) 564-6000
(803) 564-6011
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3479
SC
Other
Enumeration date
01/26/2011
Last updated
08/29/2013
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