Provider Demographics
NPI:1063815793
Name:WHEELER, JORDAN ROSS (DACM, LAC, DIPL OM)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ROSS
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DACM, LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 E MISSISSIPPI AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2013
Mailing Address - Country:US
Mailing Address - Phone:415-730-8259
Mailing Address - Fax:
Practice Address - Street 1:9071 E MISSISSIPPI AVE APT 8C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2013
Practice Address - Country:US
Practice Address - Phone:415-730-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16169171100000X
COACU.0002572171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist