Provider Demographics
NPI:1821379330
Name:HAWKINS, JORDAN KYLE (DC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:KYLE
Last Name:HAWKINS
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 1:211 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1608
Mailing Address - Country:US
Mailing Address - Phone:812-295-3346
Mailing Address - Fax:812-295-4259
Practice Address - Street 1:211 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1608
Practice Address - Country:US
Practice Address - Phone:812-295-3346
Practice Address - Fax:812-295-4259
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002598A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor