Dr. Rebecca R. Jackson LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4292 Issued in MN

Legal business name

DR. REBECCA R. JACKSON LLC

Practice address

12203 Aberdeen St NE
Suite 140
Blaine, MN 55449-4719

Phone

(763) 785-4120

Fax

(763) 785-4172

NPI assigned

Apr 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Rebecca Rene Jackson, D.C

Title

Chiropractor, Owner

Phone

(763) 785-4120

Specialties & licenses 1

Addresses

Other names 1

• Build and Balance Chiropractic Center Doing business as

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821211210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12203 ABERDEEN ST NE",
            "address_2": "SUITE 140",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494719",
            "telephone_number": "763-785-4120",
            "fax_number": "763-785-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12203 ABERDEEN ST NE",
            "address_2": "SUITE 140",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494719",
            "telephone_number": "763-785-4120",
            "fax_number": "763-785-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. REBECCA R. JACKSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "CHIROPRACTOR, OWNER",
        "authorized_official_telephone_number": "763-785-4120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Build and Balance Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Don Blakeslee DDS PA
• Amanda Rose Donnelly, PHD
• Laura Elizabeth Dougherty
• Douglas T Jonak DDS PA
• Dr. Andrew Brown Chiropracitc PC
• Douglas Alan Drew, MA, LICSW
• Gina Rose Dronen, LPCC
• Stephanie Dube
• Nishant Dwivedi, MD
• Ear Institutes, LLC

• Chiropractor in Blaine, MN
• Providers in Blaine, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.