Provider Demographics
NPI:1245049683
Name:STAFFORD, JORDAN ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:STAFFORD
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 1:8441 WAYZATA BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1378
Mailing Address - Country:US
Mailing Address - Phone:612-208-3839
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 125
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1378
Practice Address - Country:US
Practice Address - Phone:612-208-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor