Provider Demographics
NPI:1902803885
Name:MASTRONARDI, JORDAN J (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:J
Last Name:MASTRONARDI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 W HILLSBORO BLVD
Mailing Address - Street 2:STE A-11
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4330
Mailing Address - Country:US
Mailing Address - Phone:954-481-2828
Mailing Address - Fax:954-481-2830
Practice Address - Street 1:4800 W HILLSBORO BLVD
Practice Address - Street 2:STE A-11
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4371
Practice Address - Country:US
Practice Address - Phone:954-481-2828
Practice Address - Fax:954-481-2830
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381972800Medicaid
FL381972800Medicaid
FL89955ZMedicare ID - Type Unspecified