Provider Demographics
NPI:1639892102
Name:JORDAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JORDAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-409-6476
Mailing Address - Street 1:2604 W 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4731
Mailing Address - Country:US
Mailing Address - Phone:316-269-2692
Mailing Address - Fax:316-269-4443
Practice Address - Street 1:2604 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4731
Practice Address - Country:US
Practice Address - Phone:316-269-2692
Practice Address - Fax:316-269-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty