Provider Demographics
NPI:1831942416
Name:JORDAN, CARSON SAMUEL I (DC)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:SAMUEL
Last Name:JORDAN
Suffix:I
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 1:1725 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-2434
Mailing Address - Country:US
Mailing Address - Phone:601-928-9095
Mailing Address - Fax:601-928-9383
Practice Address - Street 1:1725 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2434
Practice Address - Country:US
Practice Address - Phone:601-928-9095
Practice Address - Fax:601-928-9383
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor