Provider Demographics
NPI:1649950536
Name:LOGSDON, JORDAN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAEL
Last Name:LOGSDON
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 1:220 SW 167TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6717
Mailing Address - Country:US
Mailing Address - Phone:405-637-8803
Mailing Address - Fax:
Practice Address - Street 1:220 SW 167TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6717
Practice Address - Country:US
Practice Address - Phone:405-637-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor