Jessica Southavilay Jackson, DC, LMT

NPI #1053701201 in Portland, Oregon

Provider Information

NPI Number: 1053701201
Entity Type: Individual
Name: Jessica Southavilay Jackson, DC, LMT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Chiropractor
Credential: DC, LMT
Enumeration Date: Jan 27, 2015
Last Updated: Mar 6, 2018

Practice Location

Address: 818 SE CESAR E CHAVEZ BLVD
City: Portland
State: Oregon
ZIP Code: 97214-4357
Phone: (503) 473-4680

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X
Chiropractor	111N00000X	Primary

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