Individual
CHRIS JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA, MT
Contact information
Practice address
1781 E LINCOLN RD, KOKOMO, IN 46902-3993
(765) 455-2014
(765) 455-6099
Mailing address
1781 E LINCOLN RD, KOKOMO, IN 46902-3993
(765) 455-2014
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT20901752
IN
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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