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Contact Information

DAVID B. JACKSON, M.D., S.C.
6308 8TH AVE
KENOSHA, WI53143-5031
 Phone: 262-656-2011
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
 

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for DAVID B. JACKSON, M.D., S.C.

NPI # 1528015120
LBN Legal business name DAVID B. JACKSON, M.D., S.C.
Authorized official DAVID JACKSON - (AUTHORIZED OFFICIAL)
Entity Organization
Organization subpart 1 No
Enumeration date 05/28/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
WI Medicaid 21291400
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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