DR. LARRY M. JACKSON D.N NPI 1710068499

NPI Information

NPI: 1710068499
Provider Name: DR. LARRY M. JACKSON, D.N
Classification: Nutritionist - 133NN1002X
Entity Type: Individual

Specialization: Nutrition, Education

Address:
9357 S KINGSTON AVE
CHICAGO, IL
ZIP 60617
Phone: (773) 978-5554
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DR. Larry M. Jackson, D.N is a nutrition and education nutritionist in Chicago, IL. DR. Larry M. Jackson, D.N NPI is 1710068499. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

9357 S KINGSTON AVE
CHICAGO, IL
ZIP 60617-042
Phone: (773) 978-5554
Fax: (773) 978-5802

The enumeration date for this NPI number is 10/18/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133NN1002X	Nutritionist	Nutrition, Education		ILLINOIS	Yes
2	174400000X	Specialist			ILLINOIS	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0001632277	OTHER	ILLINOIS	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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