MEDICARE: DR. JORDAN AMBROSE 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	5161	OR

General Provider Information

NPI Number	:	1063805513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN AMBROSE D.C.

Provider Business Mailing Address
First Line	:	4985 BATTLE CREEK RD SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9684
Country	:	US
Telephone Number	:	971-498-7746
Fax Number	:	503-483-2518

Provider Business Practice Location Address
First Line	:	4985 BATTLE CREEK RD SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9684
Country	:	US
Telephone Number	:	971-498-7746
Fax Number	:	503-483-2518

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/04/2026

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