Jackson Isaiah Crutch
Contractor in Dallas, TX. Individual provider (NPI-1).
NPI number1962012138
StatusActive
Last updated in NPPESAug 3, 2020
Details
- NPI
- 1962012138
- Entity type
- Individual (NPI-1)
- Name
- Jackson Isaiah Crutch
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 3, 2020
- Certification date
- Aug 3, 2020
- Last updated
- Aug 3, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
8500 N Stemmons Fwy Ste 3052Dallas, TX 75247-3969
Phone 256-665-1604
Mailing address
1845 E Northgate Dr # 245Irving, TX 75062-9991
Phone 256-665-1604
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