TRAVIS C JACKSON

SMITHFIELD, UT
NPI1528345212
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: UT  6852418-4810)
Enumeration Date2011-11-08
Last Update Date2011-11-08
Business Address
-- TRAVIS C JACKSON ATC-L
101 E 630 N APT 20
SMITHFIELD, UT 84335-9670
Phone number: 435-760-1767
Mailing Address
-- TRAVIS C JACKSON ATC-L
101 E 630 N APT 20
SMITHFIELD, UT 84335-9670
Phone number: 435-760-1767
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