Healthcare Provider Details

I. General information

NPI: 1548170848
Provider Name (Legal Business Name): DANIEL J JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9734
US

IV. Provider business mailing address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9734
US

V. Phone/Fax

Practice location:
  • Phone: 844-534-3638
  • Fax:
Mailing address:
  • Phone: 844-534-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: