Individual
CHRIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRT
Contact information
Practice address
3067 E COPPER POINT DR, MERIDIAN, ID 83642-1740
(208) 287-1733
Mailing address
19615 HARTFORD AVE, CALDWELL, ID 83605-4973
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
LRT-1569
ID
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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