Healthcare Provider Details

I. General information

NPI: 1730974353
Provider Name (Legal Business Name): JORDANN MARIE GUDORF DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 UPPER LEWISBURG SALEM RD
BROOKVILLE OH
45309-9655
US

IV. Provider business mailing address

582 UPPER LEWISBURG SALEM RD
BROOKVILLE OH
45309-9655
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-4200
  • Fax:
Mailing address:
  • Phone: 937-833-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: