Provider Demographics
NPI:1477027456
Name:JORDAN, LAUREN MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MICHELLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAUREN JORDAN, DC
Mailing Address - Street 1:330 S MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1977
Mailing Address - Country:US
Mailing Address - Phone:309-321-8377
Mailing Address - Fax:
Practice Address - Street 1:330 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1977
Practice Address - Country:US
Practice Address - Phone:309-321-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045550111N00000X
IL038013622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor