Provider Demographics
NPI:1912279712
Name:JORDAN, KELTON (DC)
Entity Type:Individual
Prefix:DR
First Name:KELTON
Middle Name:
Last Name:JORDAN
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 1:537 W BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3359
Mailing Address - Country:US
Mailing Address - Phone:215-227-2001
Mailing Address - Fax:215-227-2003
Practice Address - Street 1:537 W BUTLER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3359
Practice Address - Country:US
Practice Address - Phone:215-227-2001
Practice Address - Fax:215-227-2003
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor