NPI 1093867723

John Thomas Jackson, LMP

Practitioner Specialist Des Moines, WA

Practice location

Address: 22007 Marine View Dr S Suite 104, Des Moines, WA 98198-6259
Phone: (206) 592-1423
Fax: (206) 592-1428
Mailing address: PO Box 98530, Des Moines, WA 98198-0530

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence MA00005314 (WA)

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Registry record

NPI: 1093867723
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Jan 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.