Healthcare Provider Details

I. General information

NPI: 1407929466
Provider Name (Legal Business Name): LUCINDA JORDAN, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E 3RD ST
BLOOMINGTON IN
47401-5538
US

IV. Provider business mailing address

3901 E 3RD ST
BLOOMINGTON IN
47401-5538
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-0082
  • Fax: 812-334-1019
Mailing address:
  • Phone: 812-334-0082
  • Fax: 812-334-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: LUCINDA JORDAN
Title or Position: OWNER
Credential: D.C.
Phone: 812-334-0082