Provider Demographics
NPI:1821127713
Name:JORDAN, MAUREEN M (LIC AC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 PLEASANTVIEW AVE
Mailing Address - Street 2:#2
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3115
Mailing Address - Country:US
Mailing Address - Phone:781-929-2153
Mailing Address - Fax:
Practice Address - Street 1:MUSCLE CARE
Practice Address - Street 2:33 UNION STREET - #21
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191
Practice Address - Country:US
Practice Address - Phone:781-929-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219531171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist