| Doctor Name: | DR. STEVEN JAC TODD JACKSON |
| NPI Number: | 1134364029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, RD |
| License Number: | LD003265 |
| Business Practice Address: | 15 Kansas Street, Bldg 42 Usariem-mnd Natick, MA - 01760 |
| Business Phone Number: | 5082335808 |
| Business Fax Number: | |
| Mailing Address: | 600 Main St, Apt. 1606 WORCESTER |
| State: | MA |
| Postal Code: | 016082061 |
| Phone Number: | 6182034426 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2008 |
| NPI Last Update Date: | 12/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | LD003265 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |