Provider Demographics
NPI:1700929593
Name:MICHELS, JORDAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:L
Last Name:MICHELS
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 1:2960 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2372
Mailing Address - Country:US
Mailing Address - Phone:541-687-9528
Mailing Address - Fax:708-851-9528
Practice Address - Street 1:2960 ADAMS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2372
Practice Address - Country:US
Practice Address - Phone:541-687-9528
Practice Address - Fax:708-851-9528
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271739111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ2253 01OtherPACIFIC SOURCE
ORJ2253 01OtherPACIFIC SOURCE