Provider Demographics
NPI:1932283546
Name:JORDAN, STANLEY S (DC)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:JORDAN
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 1:307 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-2715
Mailing Address - Country:US
Mailing Address - Phone:601-928-9095
Mailing Address - Fax:601-928-9383
Practice Address - Street 1:307 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2715
Practice Address - Country:US
Practice Address - Phone:601-928-9095
Practice Address - Fax:601-928-9383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor