Kenneth Jackson

NPI #1710302096 in Monroe, Michigan

Provider Information

NPI Number: 1710302096
Entity Type: Individual
Name: Kenneth Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Feb 24, 2014
Last Updated: Feb 24, 2014

Practice Location

Address: 1001 S RAISINVILLE RD
City: Monroe
State: Michigan
ZIP Code: 48161-9754
Phone: (734) 243-7340

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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