Provider Demographics
NPI:1528408283
Name:REIDHEAD, JORDAN MERRILL (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MERRILL
Last Name:REIDHEAD
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 1:750 W DIMOND BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1501
Mailing Address - Country:US
Mailing Address - Phone:907-344-0033
Mailing Address - Fax:
Practice Address - Street 1:750 W DIMOND BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1501
Practice Address - Country:US
Practice Address - Phone:907-344-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK582111N00000X
AZ8310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor