Provider Demographics
NPI:1396810495
Name:JORDAN, ARTHUR (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2240
Mailing Address - Country:US
Mailing Address - Phone:920-794-7551
Mailing Address - Fax:
Practice Address - Street 1:2209 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2240
Practice Address - Country:US
Practice Address - Phone:920-794-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2286-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor