Provider Demographics
NPI:1295820843
Name:JACKSON, RHONDA DARLENE (DC)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:DARLENE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2295 SOUTH CHAMBERS ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-696-6691
Mailing Address - Fax:303-696-6692
Practice Address - Street 1:2295 SOUTH CHAMBERS ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-696-6691
Practice Address - Fax:303-696-6692
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801660Medicare PIN