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General NPI Number Information
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NPI Number | 1700133071
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Entity Type | Individual
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Provider Name | JITERIENCE JORDAN DC
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Gender | Male
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 313 WILLIAMS ST STE 5
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6231
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Country | US
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Telephone | 850-999-1362
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Fax |
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Provider Business Mailing Address
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Address Line | 313 WILLIAMS ST STE 5
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6231
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Country | US
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Telephone | 850-999-1362
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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 | 0104557000
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH11801
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License Number State | FL
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