MEDICARE: DR. JORDAN ETTERS DACM

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	171100000X	Acupuncturist	AC01948	TX

General Provider Information

NPI Number	:	1508594011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN ETTERS DACM

Provider Business Mailing Address
First Line	:	16015 CAIRNWAY DR UNIT 842576
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-6115
Country	:	US
Telephone Number	:	346-507-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 RICHMOND AVE STE 390
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3053
Country	:	US
Telephone Number	:	346-507-8727
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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