Individual
DR. BREONKA LATROYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
10464 E NORTHWEST HWY STE A, DALLAS, TX 75238-4608
(214) 324-5800
(214) 324-5838
Mailing address
10464 E NORTHWEST HWY STE A, DALLAS, TX 75238-4608
(214) 324-5800
(214) 324-5838
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
14680
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930211324
DIVER'S LICENSE
AR
Enumeration date
02/05/2021
Last updated
02/05/2021
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