Provider Demographics
NPI:1528601416
Name:TENPENNY, JORDAN NICHOLE (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICHOLE
Last Name:TENPENNY
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 1:100 BURNSED PL STE 1020
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6695
Mailing Address - Country:US
Mailing Address - Phone:407-971-3898
Mailing Address - Fax:
Practice Address - Street 1:100 BURNSED PL STE 1020
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6695
Practice Address - Country:US
Practice Address - Phone:407-971-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor