Individual
JACKSON WADE MCQUEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3300 W CAMELBACK RD # A21367, PHOENIX, AZ 85017-3030
(325) 977-1914
Mailing address
214 PENROSE ST, SAN ANGELO, TX 76903-8638
(325) 977-1914
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/22/2021
Last updated
01/05/2023
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