MEDICARE: DR. JORDAN LOWE D.C.

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	CH14157	FL

General Provider Information

NPI Number	:	1063147171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN LOWE D.C.

Provider Business Mailing Address
First Line	:	1313 BEACH BLVD STE C
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3429
Country	:	US
Telephone Number	:	904-372-0623
Fax Number	:	904-372-0675

Provider Business Practice Location Address
First Line	:	1313 BEACH BLVD STE C
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3429
Country	:	US
Telephone Number	:	904-372-0623
Fax Number	:	904-372-0675

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

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	10/11/2022

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