Healthcare Provider Details

I. General information

NPI: 1265268874
Provider Name (Legal Business Name): JORDAN HANDSCHUMACHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 KADE JOSEPH DR APT 106
COLUMBUS OH
43228-8297
US

IV. Provider business mailing address

5315 KADE JOSEPH DR APT 106
COLUMBUS OH
43228-8297
US

V. Phone/Fax

Practice location:
  • Phone: 614-657-7340
  • Fax:
Mailing address:
  • Phone: 614-657-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: