Individual
BRANDON CHRISTOPHER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
6810 CAMPHOR LN, SAN DIEGO, CA 92139
(619) 846-3392
Mailing address
NMCB5, FPO, AP 96601-4961
(619) 846-3392
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710-1002X
IDC
—
Enumeration date
05/10/2013
Last updated
05/10/2013
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