Provider Demographics
NPI:1235696030
Name:BRAND, JORDAN PITCHER (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PITCHER
Last Name:BRAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29259 STAMPEDE WAY
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31577 CANYON ESTATES DR STE 225
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0473
Practice Address - Country:US
Practice Address - Phone:909-283-0048
Practice Address - Fax:951-916-4895
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60925593111N00000X
CA35139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor