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General NPI Number Information
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NPI Number | 1124522958
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Entity Type | Organization
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Legal Business Name | JORDAN ORIENTAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 104 S. STELLAR PARK WAY
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City | CHANDLER
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State | AZ
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Zip | 85226-8522
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Country | US
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Telephone | 480-350-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 104 S. STELLAR PARK WAY
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City | CHANDLER
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State | AZ
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Zip | 85226-8522
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Country | US
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Telephone | 480-350-7532
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JESSICA B. M. JORDAN
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Credential | PHD, MSOM, DIPL.AC
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Telephone | 480-350-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0101
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License Number State | AZ
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