Provider Demographics
NPI:1407260631
Name:BEUTELSCHIES, JORDANA ELLEN AMELIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:ELLEN AMELIA
Last Name:BEUTELSCHIES
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 1:4015 N RUDY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-9109
Mailing Address - Country:US
Mailing Address - Phone:479-414-4336
Mailing Address - Fax:
Practice Address - Street 1:5600 EUPER LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3236
Practice Address - Country:US
Practice Address - Phone:479-484-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16071111N00000X
OK4159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor