=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568878981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN BALL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 08/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200S RURAL RD
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-921-8036
-----------------------------------------------------
Fax | 480-921-8037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200S RURAL RD
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-921-8036
-----------------------------------------------------
Fax | 480-921-8037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8367
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------