Jackson, Alyce F

Jackson, Alyce F is an individual health care provider with primary practice located at 375 N Wall St Ste P520 , Kankakee IL 60901-3493. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Jackson, Alyce F can be contacted via phone (815) 932-6632.

Contact Information

Primary practice address
375 N Wall St Ste P520 Kankakee IL 60901-3493
Phone: (815) 932-6632
Fax: (815) 932-5760
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036095105 Illinois

Profile Details

NPI number 1053419119
LBN Legal business name Jackson, Alyce F
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Mar 22nd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053419119 NPPES
Illinois MEDICAID 36095105
Illinois Other 632039

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