Provider Demographics
NPI:1730306432
Name:JACKMAN, ANN E (DC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4917
Mailing Address - Country:US
Mailing Address - Phone:508-652-9830
Mailing Address - Fax:
Practice Address - Street 1:15 E PLAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-4917
Practice Address - Country:US
Practice Address - Phone:508-652-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 2309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36681OtherBLUE CROSS BLUE SHIELD
MAY45488Medicare ID - Type UnspecifiedPROVIDER NUMBER