John Thomas Jackson, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00005314 Issued in WA

Practice address

22007 Marine View Dr S
Suite 104
Des Moines, WA 98198-6259

Phone

(206) 592-1423

Fax

(206) 592-1428

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093867723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98530",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981980530",
            "telephone_number": "206-592-1423",
            "fax_number": "206-592-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22007 MARINE VIEW DR S",
            "address_2": "SUITE 104",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981986259",
            "telephone_number": "206-592-1423",
            "fax_number": "206-592-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00005314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parke Keever Humphrey I, PT
• Xavier Inac Ibarreta, DC
• Emily Kimiko Ikebe, OTR
• Im&G PLLC
• Jesus Iniguez, MD
• Michele D Jackson, D.P.T.
• Janis Ann Jacobson, L.M.P.
• Dena Rene Johnson, LMHC
• Juanita Lee Johnson, RDH
• Magdalena Johnson, MSW

• Specialist in Des Moines, WA
• Providers in Des Moines, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.