Provider Demographics
NPI:1285199166
Name:JORDON, PAYTON (DC)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:JORDON
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 1:7012 KINGSMILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7387
Mailing Address - Country:US
Mailing Address - Phone:217-891-4551
Mailing Address - Fax:
Practice Address - Street 1:7012 KINGSMILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7387
Practice Address - Country:US
Practice Address - Phone:217-891-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor