Provider Demographics
NPI:1629671300
Name:JORDAN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:JORDAN CHIROPRACTIC, P.C.
Other - Org Name:ADVANCED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-327-0032
Mailing Address - Street 1:410 FLYNN ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717
Mailing Address - Country:US
Mailing Address - Phone:580-327-0032
Mailing Address - Fax:580-327-0033
Practice Address - Street 1:410 FLYNN ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717
Practice Address - Country:US
Practice Address - Phone:580-327-0032
Practice Address - Fax:580-327-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty