Provider Demographics
NPI:1851890040
Name:MARTIN, JORDAN GABRIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:GABRIEL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5335
Mailing Address - Country:US
Mailing Address - Phone:970-346-9031
Mailing Address - Fax:970-346-9708
Practice Address - Street 1:3000 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5335
Practice Address - Country:US
Practice Address - Phone:970-346-9031
Practice Address - Fax:970-346-9708
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor