Provider Demographics
NPI:1235773250
Name:PANGERL, JORDAN THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:THOMAS
Last Name:PANGERL
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 1:2660 NE HIGHWAY 20 STE 630
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6403
Mailing Address - Country:US
Mailing Address - Phone:541-668-6320
Mailing Address - Fax:541-668-6332
Practice Address - Street 1:2660 NE HIGHWAY 20 STE 630
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6403
Practice Address - Country:US
Practice Address - Phone:541-668-6320
Practice Address - Fax:541-668-6332
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor