Provider Demographics
NPI:1902875446
Name:JACKO, JOHN S (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:JACKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 MARKET SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-3811
Mailing Address - Country:US
Mailing Address - Phone:717-762-6300
Mailing Address - Fax:717-762-1831
Practice Address - Street 1:1977 MARKET SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-3811
Practice Address - Country:US
Practice Address - Phone:717-762-6300
Practice Address - Fax:717-762-1831
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003848L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU43622Medicare UPIN
PA024425Medicare ID - Type Unspecified