Provider Demographics
NPI:1750489084
Name:JOURDAN, MICHELLE DOROTHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DOROTHEA
Last Name:JOURDAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 1/2 7TH AVE N
Mailing Address - Street 2:UNIT B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2516
Mailing Address - Country:US
Mailing Address - Phone:239-848-6499
Mailing Address - Fax:
Practice Address - Street 1:116 1/2 7TH AVE N
Practice Address - Street 2:UNIT B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2516
Practice Address - Country:US
Practice Address - Phone:239-848-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70059Medicare ID - Type Unspecified