Provider Demographics
NPI:1720335466
Name:MERRILL, JORDAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SCOTT
Last Name:MERRILL
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 1:2995 FORT HENRY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4068
Mailing Address - Country:US
Mailing Address - Phone:423-765-9256
Mailing Address - Fax:423-765-9258
Practice Address - Street 1:2995 FORT HENRY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4068
Practice Address - Country:US
Practice Address - Phone:423-765-9256
Practice Address - Fax:423-765-9258
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4329111N00000X
TNDC0000002794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor