Healthcare Provider Details

I. General information

NPI: 1063295392
Provider Name (Legal Business Name): DR JORDAN DC GREENLIGHT CHIROPRACTIC LAKE FOREST CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23101 LAKE CENTER DR STE 110
LAKE FOREST CA
92630-2882
US

IV. Provider business mailing address

PO BOX 3265
RANCHO SANTA FE CA
92067-3265
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN ZIEGLER
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 719-321-6308