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General NPI Number Information
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NPI Number | 1205575958
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Entity Type | Individual
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Provider Name | JORDAN MATTHEW LEA DC
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 8680 W WARM SPRINGS RD STE 155
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City | LAS VEGAS
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State | NV
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Zip | 89148-1828
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Country | US
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Telephone | 702-413-7307
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 N TORREY PINES DR APT 2048
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City | LAS VEGAS
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State | NV
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Zip | 89108-6526
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Country | US
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Telephone | 618-979-3011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B01939
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License Number State | NV
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