Provider Demographics
NPI:1205998002
Name:GARLOCK, JORDAN A (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:GARLOCK
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 1:3 EASTVIEW PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9783
Mailing Address - Country:US
Mailing Address - Phone:207-284-1800
Mailing Address - Fax:207-284-1802
Practice Address - Street 1:3 EASTVIEW PKWY STE 3
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-9783
Practice Address - Country:US
Practice Address - Phone:207-284-1800
Practice Address - Fax:207-284-1802
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1234111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8656Medicare ID - Type Unspecified