| Doctor Name: | KEVIN JACKSON |
| NPI Number: | 1992932404 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 17273 State Route 104 Chillicothe, OH - 456019718 |
| Business Phone Number: | 7407731141 |
| Business Fax Number: | |
| Mailing Address: | 5615 Pleasant Valley Rd Sw, LANCASTER |
| State: | OH |
| Postal Code: | 431308916 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2009 |
| NPI Last Update Date: | 06/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| 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 |