Dominek Jackson

NPI #1598174914 in Inkster, Michigan

Provider Information

NPI Number: 1598174914
Entity Type: Individual
Name: Dominek Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: Aug 11, 2014
Last Updated: Aug 4, 2015

Practice Location

Address: 28017 SOMERSET ST
City: Inkster
State: Michigan
ZIP Code: 48141-1166
Phone: (313) 971-8190

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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