Provider Demographics
NPI:1396198289
Name:MEYER, JORDAN MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:MEYER
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 1:818 CHESHIRE CT APT 13
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-7118
Mailing Address - Country:US
Mailing Address - Phone:562-581-2768
Mailing Address - Fax:
Practice Address - Street 1:1019 W GALENA AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3819
Practice Address - Country:US
Practice Address - Phone:815-232-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-013002111N00000X
IA081991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor