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Individual

DANIEL SHANE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
5501 NW 62ND TER STE 102, KANSAS CITY, MO 64151-2412
(816) 453-4485
(816) 453-4101
Mailing address
5501 NW 62ND TER STE 102, KANSAS CITY, MO 64151-2412
(816) 453-4485
(816) 453-4101

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03205
KS
225100000X
Physical Therapist
2002029465
MO

Other

Enumeration date
07/22/2005
Last updated
10/06/2022
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