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General NPI Number Information
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NPI Number | 1245822758
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Entity Type | Individual
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Provider Name | JORDAN MICHAEL MAXWELL DC
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Gender | Male
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1130 E MISSOURI AVE STE 402
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City | PHOENIX
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State | AZ
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Zip | 85014-2724
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Country | US
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Telephone | 315-391-7949
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Fax |
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Provider Business Mailing Address
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Address Line | 4218 STEPPING STONE LN
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City | LIVERPOOL
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State | NY
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Zip | 13090-1826
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Country | US
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Telephone | 315-391-7949
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 012285
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 007444
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X01371701
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License Number State | NY
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