MEDICARE: JORDAN HART DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12304	TX

General Provider Information

NPI Number	:	1053758854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HART DC

Provider Business Mailing Address
First Line	:	7429 BRENTCOVE CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-1806
Country	:	US
Telephone Number	:	214-683-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	7429 BRENTCOVE CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-1806
Country	:	US
Telephone Number	:	214-683-1980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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Directions to “ JORDAN HART DC” Practice Location

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