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NPI Code Detail

MEDICARE: MR. JORDAN KRISTOPHER BROYER

MEDICARE: MR. JORDAN KRISTOPHER BROYER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558220954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JORDAN KRISTOPHER BROYER
Provider Business Mailing Address
First Line : 301 SHADY BROOK HTS
Second Line :
City : GREENWOOD
State : IN
Zip : 46142-8954
Country : US
Telephone Number : 317-567-9307
Fax Number :
Provider Business Practice Location Address
First Line : 5915 S EMERSON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-1971
Country : US
Telephone Number : 317-567-9307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2026
Last Update Date : 01/20/2026

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