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Dr. Larry M. Jackson, DN
Specialist in Chicago, Illinois
NPI 1710068499

Larry M. Jackson is a Specialist based in Chicago, IL. Larry M. Jackson practices in Chicago, IL and has the professional credentials of DN. The NPI Number for Larry M. Jackson is 1710068499 and holds a License No. (Illinois).

The current practice location address for Larry M. Jackson is 9357 S Kingston Ave, Chicago, IL and can be reached out via phone at 773-978-5554 and via fax at 773-978-5802. You can also correspond with Larry M. Jackson through the mailing address at 9357 S KINGSTON AVE, CHICAGO, IL - 60617-4042 (mailing address contact number: 773-978-5554).

Location: 9357 S Kingston Ave, Chicago, IL, 60617-4042
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Provider Profile Details
NPI Number
1710068499
Provider Name
Larry M. Jackson
Credential
DN
Provider Entity Type
Individual
Gender
Male
Address
9357 S Kingston Ave, Chicago, IL, 60617-4042
Phone Number
773-978-5554
Fax Number
773-978-5802
Provider Enumeration Date
10/18/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0001632277 01 IL BCBS
institution
Provider Business Practice Location Address Details
Address
9357 S Kingston Ave
City
State
Zip
60617-4042
Phone Number
773-978-5554
Fax Number
773-978-5802
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Provider Business Mailing Address Details
Address
9357 S Kingston Ave
City
State
Zip
60617-4042
Phone Number
773-978-5554
Fax Number
773-978-5802
person
Provider's Taxonomy Details 1
Type
Dietary & Nutritional Service Providers
Classification
Nutritionist
Speciality
Nutrition, Education
Taxonomy
License No.
(Illinois)
Definition
Definition to come...
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Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
License No.
(Illinois)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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