Healthcare Provider Details

I. General information

NPI: 1740553957
Provider Name (Legal Business Name): DR. JORDAN MACKNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 N SCOTTSDALE RD STE 202
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

18511 N SCOTTSDALE RD STE 202
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7242
  • Fax: 480-306-6246
Mailing address:
  • Phone: 480-306-7242
  • Fax: 480-306-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8241
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: