Provider Demographics
NPI:1487633632
Name:DEGRAZIA, JORDAN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:DEGRAZIA
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 1:610 EASTBURY DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-887-6992
Mailing Address - Fax:319-887-6983
Practice Address - Street 1:610 EASTBURY DR.
Practice Address - Street 2:SUITE 3
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-887-6992
Practice Address - Fax:319-887-6983
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265678Medicaid
IA50709OtherBLUE CROSS & BLUE SHIELD
IAU92474Medicare UPIN
IAI6876Medicare ID - Type Unspecified