| NPI | 1801061932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN S JACKO Owner 304-754-7130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10391) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2009-05-07 |