Healthcare Provider Details

I. General information

NPI: 1689595399
Provider Name (Legal Business Name): JAMIA JORDAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 WOODSON RD
OVERLAND MO
63114-5644
US

IV. Provider business mailing address

2050 WOODSON RD
OVERLAND MO
63114-5644
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-0725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2026020906
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: