Provider Demographics
NPI:1134541923
Name:JOHNSON, JORDAN PATRICK (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:PATRICK
Last Name:JOHNSON
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 1:512 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3258
Mailing Address - Country:US
Mailing Address - Phone:603-534-1204
Mailing Address - Fax:
Practice Address - Street 1:512 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3258
Practice Address - Country:US
Practice Address - Phone:828-544-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH927111N00000X
NC4777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor