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1235779166
JOHN MARK JACKSON
PUEBLO, CO
NPI
1235779166
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-01-08
Last Update Date
2020-01-08
Business Address
JOHN MARK JACKSON
3470 BALTIMORE AVE
PUEBLO, CO 81008-1520
Phone number: 719-545-1181
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Mailing Address
JOHN MARK JACKSON
208 CIRCLE DR W
CANON CITY, CO 81212-2439
Phone number:
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