Individual
BRADLEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2921 RANDOLPH RD, JANESVILLE, WI 53545-0665
(608) 866-0689
Mailing address
4100 WYNDHAM DR NE, CEDAR RAPIDS, IA 52402-2565
(608) 866-0689
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
12/30/2024
Last updated
01/07/2025
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