Provider Demographics
NPI:1144481862
Name:JORDAN, JENNIFER MICHELLE (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 BOSTON POST ROAD
Mailing Address - Street 2:UNIT #8
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2053
Mailing Address - Country:US
Mailing Address - Phone:860-439-0597
Mailing Address - Fax:860-439-0691
Practice Address - Street 1:262 BOSTON POST ROAD
Practice Address - Street 2:UNIT #8
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2053
Practice Address - Country:US
Practice Address - Phone:860-439-0597
Practice Address - Fax:860-439-0691
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor