Healthcare Provider Details

I. General information

NPI: 1073427415
Provider Name (Legal Business Name): KRISTIN JORDAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 ACWORTH DUE WEST RD NW
ACWORTH GA
30101-5819
US

IV. Provider business mailing address

2464 SALUDA DR NW
ACWORTH GA
30101-8087
US

V. Phone/Fax

Practice location:
  • Phone: 770-975-0585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066529
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: