Brian Jeffrey Jackson, CO, AT

NPI #1134636921 in Saint Paul, Minnesota

Provider Information

NPI Number: 1134636921
Entity Type: Individual
Name: Brian Jeffrey Jackson, CO, AT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Orthotist
Credential: CO, AT
Enumeration Date: Jan 3, 2018
Last Updated: Jan 3, 2018

Practice Location

Address: 1600 UNIVERSITY AVE W STE 10
City: Saint Paul
State: Minnesota
ZIP Code: 55104-3898
Phone: (651) 646-7246

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Orthotist	222Z00000X	Primary

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