Healthcare Provider Details

I. General information

NPI: 1205998002
Provider Name (Legal Business Name): JORDAN A GARLOCK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 US ROUTE 1 STE 4D
SCARBOROUGH ME
04074-2100
US

IV. Provider business mailing address

426 US ROUTE 1 STE 4D
SCARBOROUGH ME
04074-2100
US

V. Phone/Fax

Practice location:
  • Phone: 207-671-7071
  • Fax: 207-883-9924
Mailing address:
  • Phone: 207-671-7071
  • Fax: 207-883-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR1234
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: