Chad William Jackson, PT, DPT, OCS

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

2001019379 Issued in MO

Practice address

822 S Walnut St
Maryville, MO 64468-2565

Phone

(660) 562-2705

Fax

(660) 562-7967

NPI assigned

Aug 1, 2007

Sex

Male

Sole proprietor

No

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": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185926400000",
    "number": "1710177142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 S WALNUT ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682565",
            "telephone_number": "660-562-2705",
            "fax_number": "660-562-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 S WALNUT ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682565",
            "telephone_number": "660-562-2705",
            "fax_number": "660-562-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHAD",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2007-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "2001019379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Marie Hornbuckle
• William G Humphreys, M.D.
• Kathleen M. Hurayt, F.N.P.
• Kelsi Huseman, ATC
• Hy-Vee Inc
• Jacobson Counseling LLC
• Christine Marie Jacobson, LCSW
• Hailey Dawn Jahnel, DPT
• Jeffry P. Gardner, D.D.S.
• Michelle Ann Jones, LCSW

• Orthopedic Physical Therapist in Maryville, MO
• Providers in Maryville, MO by specialty
• Orthopedic Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.