Provider Demographics
NPI:1275694226
Name:AIGEN, JORDAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:AIGEN
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 1:2309 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6366
Mailing Address - Country:US
Mailing Address - Phone:561-739-5393
Mailing Address - Fax:561-369-5960
Practice Address - Street 1:2309 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE #5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6366
Practice Address - Country:US
Practice Address - Phone:561-739-5393
Practice Address - Fax:561-369-5960
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU89069Medicare UPIN