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General NPI Number Information
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NPI Number | 1235097452
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Entity Type | Individual
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Provider Name | CHARLES TIMOTHY JORDAN CDRS
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Gender | Male
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 14 SUTTON PL
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City | OAK HILL
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State | WV
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Zip | 25901-2059
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Country | US
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Telephone | 304-640-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SUTTON PL
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City | OAK HILL
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State | WV
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Zip | 25901-2059
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Country | US
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Telephone | 304-640-2818
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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 | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number |
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License Number State | WV
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