Provider Demographics
NPI:1851059992
Name:WARNER, JORDAN (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WARNER
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 1:12805 W 134TH PL APT 29103
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4947
Mailing Address - Country:US
Mailing Address - Phone:209-605-9504
Mailing Address - Fax:
Practice Address - Street 1:343 W 23RD ST STE 4
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-9502
Practice Address - Country:US
Practice Address - Phone:913-549-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor