Healthcare Provider Details

I. General information

NPI: 1790605541
Provider Name (Legal Business Name): JORDAN LAU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PATERSON AVE STE 101
EAST RUTHERFORD NJ
07073-1837
US

IV. Provider business mailing address

186 PATERSON AVE STE 101
EAST RUTHERFORD NJ
07073-1837
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-3040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00819800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: