| Jackson PK, LLC | |
|
9701 Brodie Ln Ste 202 Austin TX 78748-6284 | |
| (512) 326-2520 | |
| Not Available |
| Full Name | Jackson PK, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 9701 Brodie Ln Ste 202, Austin, Texas |
| Authorized Official Name and Position | Paul a Shrogin (CLINICIAN) |
| Authorized Official Contact | 8054783760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson PK, LLC 9701 Brodie Ln Ste 202 Austin TX 78748-6284 Ph: (512) 326-2520 | Jackson PK, LLC 9701 Brodie Ln Ste 202 Austin TX 78748-6284 Ph: (512) 326-2520 |
| NPI Number | 1750867826 |
|---|---|
| Provider Enumeration Date | 07/12/2018 |
| Last Update Date | 07/12/2018 |
| Medicare PECOS PAC ID | 0547518136 |
|---|---|
| Medicare Enrollment ID | O20180730000895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750867826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 13075 (Texas) | Primary |
| Provider Name | Paul Abram Shrogin |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1275907263 PECOS PAC ID: 1456609049 Enrollment ID: I20180730001031 |
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