Provider Demographics
NPI:1477252237
Name:HAUSE, JORDAN (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HAUSE
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 1:280 CORPORATE WAY SE # 102
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3803
Mailing Address - Country:US
Mailing Address - Phone:321-586-7145
Mailing Address - Fax:
Practice Address - Street 1:280 CORPORATE WAY SE # 102
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3803
Practice Address - Country:US
Practice Address - Phone:321-586-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty