MEDICARE: JORDAN CHIROPRACTIC CENTER

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	178	WV

General Provider Information

NPI Number	:	1891885729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	4024 MACCORKLE AVE SW
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1510
Country	:	US
Telephone Number	:	304-768-7671
Fax Number	:

Provider Business Practice Location Address
First Line	:	4024 MACCORKLE AVE SW
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1510
Country	:	US
Telephone Number	:	304-768-7671
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. WILLIAM JORDAN
Credential	:	D.C.
Telephone Number	:	304-768-7671

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/05/2007

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