Provider Demographics
NPI:1598875569
Name:JORDAN, REBECCA J (DC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N MCLEAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5815
Mailing Address - Country:US
Mailing Address - Phone:316-269-2692
Mailing Address - Fax:316-269-4443
Practice Address - Street 1:555 N MCLEAN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5815
Practice Address - Country:US
Practice Address - Phone:316-269-2692
Practice Address - Fax:316-269-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS01-04272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060067Medicare ID - Type Unspecified
KSU49816Medicare UPIN