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General NPI Number Information
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NPI Number | 1285136739
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Entity Type | Individual
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Provider Name | JESSICA B. M. JORDAN PHD DIPL AC MSOM LAC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 104 S STELLAR PKWY
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City | CHANDLER
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State | AZ
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Zip | 85226-3725
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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 | JORDAN ORIENTAL MEDICINE, LLC 104 S STELLAR PARK WAY
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City | CHANDLER
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State | AZ
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Zip | 85226-3725
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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 |
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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 | 110
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License Number State | KY
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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 | 0101
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License Number State | AZ
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