Provider Demographics
NPI:1013791292
Name:ROMEO, JORDAN TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TYLER
Last Name:ROMEO
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0013
Mailing Address - Country:US
Mailing Address - Phone:315-280-0586
Mailing Address - Fax:315-282-2332
Practice Address - Street 1:135 N. COURT ST.
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163
Practice Address - Country:US
Practice Address - Phone:315-280-0586
Practice Address - Fax:315-282-2332
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor