Provider Demographics
NPI:1760003974
Name:WEIL, JORDAN (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WEIL
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 1:4210 SOUTHTOWNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2635
Mailing Address - Country:US
Mailing Address - Phone:715-598-1829
Mailing Address - Fax:
Practice Address - Street 1:4210 SOUTHTOWNE DRIVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2635
Practice Address - Country:US
Practice Address - Phone:715-598-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5527-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor