Individual
RONALD JOSEPH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
450 LEWIS ST., PAGOSA SPRINGS, CO 81147
(970) 264-2880
Mailing address
154 WOODSMAN DR,, PAGOSA SPRINGS, CO 81147
(970) 946-3426
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5112
CO
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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