Provider Demographics
NPI:1770002966
Name:RADER, JORDAN (DC, BS, AE)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:RADER
Suffix:
Gender:M
Credentials:DC, BS, AE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 TOWNSHIP ROAD 2306
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864
Mailing Address - Country:US
Mailing Address - Phone:330-614-2900
Mailing Address - Fax:
Practice Address - Street 1:918 KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3619
Practice Address - Country:US
Practice Address - Phone:419-282-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor