MEDICARE: DR. JEREMY SCOTT JORDAN 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	1061	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1061	OTHER	MS	MS DOCTORATE OF CHIROPRACTIC LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124180153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY SCOTT JORDAN D.C.

Provider Business Mailing Address
First Line	:	2718 WALTON DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5424
Country	:	US
Telephone Number	:	228-860-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 WALTON DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5424
Country	:	US
Telephone Number	:	228-860-8868
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	04/17/2024

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