Jackson, Larry M.

Jackson, Larry M. is an sole proprietor health care provider with primary practice located at 9357 S Kingston Ave , Chicago IL 60617-4042. He recently has 2 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Nutrition, Education, Other Service Providers / Specialist. Dietary & Nutritional Service Providers / Nutrition, Education is his primary health care specialty. Jackson, Larry M. can be contacted via phone (773) 978-5554.

Contact Information

Primary practice address
9357 S Kingston Ave Chicago IL 60617-4042
Phone: (773) 978-5554
Fax: (773) 978-5802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutrition, Education 133NN1002X Illinois
Other Service Providers / Specialist 174400000X Illinois

Profile Details

NPI number 1710068499
LBN Legal business name Jackson, Larry M.
Credentials Doctor of Nursing (DN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 18th, 2006
Last updated Jul 8th, 2007 - about 18 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 1710068499 NPPES
Illinois Other 0001632277 BCBS

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