MEDICARE: JORDAN THOMAS PANGERL 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	6036	OR

General Provider Information

NPI Number	:	1235773250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN THOMAS PANGERL DC

Provider Business Mailing Address
First Line	:	2660 NE HIGHWAY 20 STE 630
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6403
Country	:	US
Telephone Number	:	541-668-6320
Fax Number	:	541-668-6332

Provider Business Practice Location Address
First Line	:	2660 NE HIGHWAY 20 STE 630
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6403
Country	:	US
Telephone Number	:	541-668-6320
Fax Number	:	541-668-6332

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	08/26/2022

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Directions to “ JORDAN THOMAS PANGERL DC” Practice Location

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