Healthcare Provider Details

I. General information

NPI: 1851804348
Provider Name (Legal Business Name): ANDREW JORDAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 BROADWAY # 1A
SAN FRANCISCO CA
94109-2539
US

IV. Provider business mailing address

810 GONZALEZ DR APT 4A
SAN FRANCISCO CA
94132-2221
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-3800
  • Fax:
Mailing address:
  • Phone: 410-340-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number34004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: