Provider Demographics
NPI:1043973449
Name:JORDAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JORDAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-258-7444
Mailing Address - Street 1:515 HOWSER RD
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47126-8612
Mailing Address - Country:US
Mailing Address - Phone:812-258-7444
Mailing Address - Fax:
Practice Address - Street 1:515 HOWSER RD
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:IN
Practice Address - Zip Code:47126-8612
Practice Address - Country:US
Practice Address - Phone:812-258-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty