Provider Demographics
NPI:1528411543
Name:SCHROTER, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SCHROTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BLUE RIDGE HWY
Mailing Address - Street 2:SUITE #12
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-4458
Mailing Address - Country:US
Mailing Address - Phone:706-745-4140
Mailing Address - Fax:
Practice Address - Street 1:108 BLUE RIDGE HWY
Practice Address - Street 2:SUITE #12
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-4458
Practice Address - Country:US
Practice Address - Phone:706-745-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor