Provider Demographics
NPI:1649980616
Name:WEST, JORDAN (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WEST
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 1:5272 HOLY NECK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23437-9399
Mailing Address - Country:US
Mailing Address - Phone:757-633-1119
Mailing Address - Fax:
Practice Address - Street 1:705 QUINCE PL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0769
Practice Address - Country:US
Practice Address - Phone:757-410-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104557875OtherBOARD OF MEDICINE