MEDICARE: JORDAN PITCHER BRAND DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	60925593	WA
2	111N00000X	Chiropractor	35139	CA

General Provider Information

NPI Number	:	1235696030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN PITCHER BRAND DC

Provider Business Mailing Address
First Line	:	29259 STAMPEDE WAY
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-7634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31577 CANYON ESTATES DR STE 225
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0473
Country	:	US
Telephone Number	:	909-283-0048
Fax Number	:	951-916-4895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	03/20/2024

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Directions to “ JORDAN PITCHER BRAND DC” Practice Location

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