Healthcare Provider Details

I. General information

NPI: 1760398200
Provider Name (Legal Business Name): MICHELLE JORDON MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 KENNEDY AVE
HIGHLAND IN
46322-1128
US

IV. Provider business mailing address

3426 PENINSULA DR APT 16
PORTAGE IN
46368-4274
US

V. Phone/Fax

Practice location:
  • Phone: 219-803-6630
  • Fax: 219-937-7237
Mailing address:
  • Phone: 219-256-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20902178
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: