NPI 1134636921

Brian Jeffrey Jackson, COAT

Practitioner Orthotist Saint Paul, MN

Practice location

Address: 1600 University Ave W STE 10, Saint Paul, MN 55104-3898
Phone: (651) 646-7246
Fax: (651) 641-0726
Mailing address: 1258 Galtier St, Saint Paul, MN 55117-4456

Registered specialties

Orthotist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X

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Registry record

NPI: 1134636921
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Jan 2018
Record last updated: 3 Jan 2018

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.