JEFFERSON JACKSON WETHERINGTON

BOISE, ID
NPI1992030803
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID  AT468)
Additional Taxonomies2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MI  2601001331)
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: FL  AL 2738)
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: OR  10160747)
246Z00000X Specialist/Technologist, Other
(Licence: ID  #13-0839)
Enumeration Date2009-10-09
Last Update Date2020-03-19
Business Address
JEFFERSON JACKSON WETHERINGTON MS, LAT, ATC
600 N ROBBINS RD STE 200
BOISE, ID 83702-4565
Phone number: 616-447-9996
Mailing Address
JEFFERSON JACKSON WETHERINGTON MS, LAT, ATC
600 N ROBBINS RD STE 401
BOISE, ID 83702-4566
Phone number: 208-706-9439