Larry M. Jackson is a Specialist in Chicago, Illinois. Larry M. Jackson practices all healthcare services and medical treatments related to Specialist. The NPI Number for Larry M. Jackson is 1710068499. The last update date is 2007-07-08.
Larry M. Jackson's current location address is 9357 S Kingston Ave, Chicago, Illinois. You can contact this provider via phone number 7739785554 and fax number 7739785802. The mailing address for Larry M. Jackson is 9357 S Kingston Ave, Chicago, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Larry M. Jackson |
|---|---|
| Address | 9357 S Kingston Ave, Chicago, Illinois |
| Phone Number | 7739785554 |
| Fax Number | 7739785802 |
| Sole Proprietor | Y |
| Credentials | D.N |
NPI Number Detail
| NPI Number | 1710068499 |
|---|---|
| Provider Enumeration Date | 2006-10-18 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 9357 S Kingston Ave |
|---|---|
| City | Chicago |
| State | Illinois (IL) |
| Post Code | 606174042 |
| Phone Number | 7739785554 |
| Fax Number | 7739785802 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
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Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1632277 | IL | BCBS |
Post Comment/ Review Below
What is the unique identification code assigned to Larry M. Jackson by the Centers for Medicare & Medicaid Services?
The Larry M. Jackson has been issued the NPI (National Provider Identifier) 1710068499. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Larry M. Jackson?
The Larry M. Jackson is physically situated at 9357 S Kingston Ave, in the city of Chicago, state of IL, with the postal code 606174042.
What is Larry M. Jackson's area of expertise and its corresponding taxonomy classification?
The Larry M. Jackson's field of specialization is Specialist, and it falls under the taxonomy code 174400000X, which categorizes healthcare providers based on their areas of practice.
On what date was the 1710068499 assigned to Larry M. Jackson?
The Larry M. Jackson was issued its 1710068499 on 2006-10-18, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details pertaining to Larry M. Jackson last refreshed?
The information related to the Larry M. Jackson, including its address, specialty, and other relevant details, was last updated on 2007-07-08.