Provider Demographics
NPI:1245505544
Name:SPEARES, JORDAN (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SPEARES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:115 BROAD STREET RD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2272
Mailing Address - Country:US
Mailing Address - Phone:804-784-0161
Mailing Address - Fax:804-784-2704
Practice Address - Street 1:115 BROAD STREET RD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2272
Practice Address - Country:US
Practice Address - Phone:804-784-0161
Practice Address - Fax:804-784-2704
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03691111NR0400X
VA104556955111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation