Provider Demographics
NPI:1215404090
Name:DAVIS, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 LINCOLN MEADOWS CIR APT 811
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6136
Mailing Address - Country:US
Mailing Address - Phone:205-412-4210
Mailing Address - Fax:
Practice Address - Street 1:1785 NORTHWIND BLVD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9617
Practice Address - Country:US
Practice Address - Phone:205-412-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor