Provider Demographics
NPI:1477643302
Name:JORDAN, WILLIAM V (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:JORDAN
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 1:411 D. STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303
Mailing Address - Country:US
Mailing Address - Phone:304-768-7671
Mailing Address - Fax:304-768-6491
Practice Address - Street 1:411 D. STREET
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303
Practice Address - Country:US
Practice Address - Phone:304-768-7671
Practice Address - Fax:304-768-6491
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720345OtherMOUNTIAN STATE BC/BS
WVT32260Medicare UPIN
WVT32260Medicare UPIN
WV0388122Medicare PIN