Provider Demographics
NPI:1609086537
Name:JORDAN, JEFF S (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:S
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:THE
Other - Middle Name:BACK
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DBA
Mailing Address - Street 1:819 N HARBOR DR STE A100
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2006
Mailing Address - Country:US
Mailing Address - Phone:310-937-2600
Mailing Address - Fax:
Practice Address - Street 1:819 N HARBOR DR STE A-100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2006
Practice Address - Country:US
Practice Address - Phone:310-937-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24148111N00000X
CADC 24148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24148OtherSTATE OF CALIFORNIA BOARD OF CHIROPRACTIC