Individual
KEVIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17273 STATE ROUTE 104, CHILLICOTHE, OH 45601-9718
(740) 773-1141
Mailing address
5615 PLEASANT VALLEY RD SW, LANCASTER, OH 43130-8916
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
OH
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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