Provider Demographics
NPI:1013465632
Name:MOUSLEY, JORDAN (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MOUSLEY
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 1:6717 S 900 E STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5755
Mailing Address - Country:US
Mailing Address - Phone:801-432-7511
Mailing Address - Fax:801-432-7516
Practice Address - Street 1:6717 S 900 E STE 101
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5755
Practice Address - Country:US
Practice Address - Phone:801-432-7511
Practice Address - Fax:801-432-7516
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10071416-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor