MEDICARE: DR. JORDAN AXE 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	CH11262	FL

General Provider Information

NPI Number	:	1194116368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN AXE D.C.

Provider Business Mailing Address
First Line	:	6595 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3316
Country	:	US
Telephone Number	:	863-940-3444
Fax Number	:

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

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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Directions to “ DR. JORDAN AXE D.C.” Practice Location

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