Dr. Larry M. Jackson, DN - Chicago, IL

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.

Location: 9357 S Kingston Ave, Chicago, IL, 60617-4042

NPI Number

1710068499

Provider Name

Larry M. Jackson

Credential

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

10/19/2024

Identifier	Type	State	Issuer
0001632277	01	IL	BCBS

Address

9357 S Kingston Ave

City

Chicago

State

Illinois

Zip

60617-4042

Phone Number

773-978-5554

Fax Number

773-978-5802

Address

9357 S Kingston Ave

City

Chicago

State

Illinois

Zip

60617-4042

Phone Number

773-978-5554

Fax Number

773-978-5802

Type

Dietary & Nutritional Service Providers

Classification

Nutritionist

Speciality

Nutrition, Education

Taxonomy

133NN1002X

License No.

(Illinois)

Definition

Definition to come...

Type

Other Service Providers

Classification

Specialist

Speciality

Taxonomy

174400000X

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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