Provider Demographics
NPI:1730936725
Name:JACKSON, ADAM WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WAYNE
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TURTLE HOLW
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-5059
Mailing Address - Country:US
Mailing Address - Phone:601-672-9356
Mailing Address - Fax:
Practice Address - Street 1:119 COLONY CROSSING WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6322
Practice Address - Country:US
Practice Address - Phone:601-898-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor