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Michael Jackson
NPI 1801365382 · on the registry since 2018 · sole proprietor
Practice
- Address
- 5537b N Glenwood St Ste B
Garden City, ID 83714 - Phone
- (208) 789-9075
- Fax
- (208) 917-2818
Registry record
- Primary taxonomy
- 332B00000X
332B00000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-11-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho