Provider Demographics
NPI:1457920597
Name:MASSO, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:MASSO
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 1:17102 HIGHWAY 46 W STE 14
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-7120
Mailing Address - Country:US
Mailing Address - Phone:830-214-2211
Mailing Address - Fax:
Practice Address - Street 1:17102 HIGHWAY 46 W STE 14
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-7120
Practice Address - Country:US
Practice Address - Phone:830-214-2211
Practice Address - Fax:830-214-2212
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14559OtherLICENSE