Provider Demographics
NPI:1477119055
Name:BORING, JORDAN BLAKE (L AC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAKE
Last Name:BORING
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 TIPTON LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-1855
Mailing Address - Country:US
Mailing Address - Phone:865-296-2955
Mailing Address - Fax:
Practice Address - Street 1:2314 TIPTON LOOP RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-1855
Practice Address - Country:US
Practice Address - Phone:865-296-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist