Individual
CHAVIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
101 W 8TH AVE, SPOKANE, WA 99204-2307
(801) 707-3121
Mailing address
914 E SAN REMO AVE, GILBERT, AZ 85234-3558
(801) 707-3121
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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