Provider Demographics
NPI:1811579907
Name:CURTIS, CHRISTOPHER JORDAN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JORDAN
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SAWTOOTH DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5974
Mailing Address - Country:US
Mailing Address - Phone:708-732-0944
Mailing Address - Fax:
Practice Address - Street 1:102 SAWTOOTH DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5974
Practice Address - Country:US
Practice Address - Phone:863-602-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver