Provider Demographics
NPI:1639700826
Name:PERONA, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:PERONA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17684 86TH ST N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2636
Mailing Address - Country:US
Mailing Address - Phone:561-316-8509
Mailing Address - Fax:
Practice Address - Street 1:17684 86TH ST N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-2636
Practice Address - Country:US
Practice Address - Phone:561-316-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor