Kim B Jackson

NPI #1003415464 in Glen Cove, New York

Provider Information

NPI Number: 1003415464
Entity Type: Individual
Name: Kim B Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Enumeration Date: Oct 18, 2020
Last Updated: Oct 18, 2020

Practice Location

Address: 29 GLEN COVE AVE STE 212
City: Glen Cove
State: New York
ZIP Code: 11542-2831
Phone: (516) 384-7670

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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