Healthcare Provider Details

I. General information

NPI: 1912240383
Provider Name (Legal Business Name): AIKEN PHYSICAL MEDICINE AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 WHISKEY RD
AIKEN SC
29803-6197
US

IV. Provider business mailing address

2741 WHISKEY RD
AIKEN SC
29803-6197
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0217
  • Fax: 803-226-0459
Mailing address:
  • Phone: 803-226-0217
  • Fax: 803-226-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number17794
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3663
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number000695
License Number StateSC

VIII. Authorized Official

Name: DR. PHILIP R JORDAN
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 803-226-0217