Provider Demographics
NPI:1407943434
Name:JORDAN CHIROPRACTIC
Entity Type:Organization
Organization Name:JORDAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-269-2692
Mailing Address - Street 1:555 N MCLEAN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5815
Mailing Address - Country:US
Mailing Address - Phone:316-269-2692
Mailing Address - Fax:316-269-4443
Practice Address - Street 1:555 N MCLEAN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5815
Practice Address - Country:US
Practice Address - Phone:316-269-2692
Practice Address - Fax:316-269-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU49816Medicare UPIN
KS060440Medicare ID - Type Unspecified