Healthcare Provider Details

I. General information

NPI: 1770072571
Provider Name (Legal Business Name): ALEX JORDAN SILVER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 PICO BLVD # A
SANTA MONICA CA
90405-2004
US

IV. Provider business mailing address

2638 4TH ST APT D
SANTA MONICA CA
90405-4257
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-6656
  • Fax:
Mailing address:
  • Phone: 310-995-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: