Provider Demographics
NPI:1548907033
Name:STORM, JACKSON (ASCM-CEP)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:STORM
Suffix:
Gender:M
Credentials:ASCM-CEP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2908 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 RIVER DR S UNIT 4/5
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1856
Practice Address - Country:US
Practice Address - Phone:406-217-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist