Provider Demographics
NPI:1538386248
Name:PORMAN, L JON (DC)
Entity type:Individual
Prefix:
First Name:L
Middle Name:JON
Last Name:PORMAN
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 1:319 W VERANO PL
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7331
Mailing Address - Country:US
Mailing Address - Phone:480-545-7270
Mailing Address - Fax:
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:STE 203
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-812-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5435111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932790OtherBLUECROSS BLUESHIELD
AZ66715Medicare ID - Type Unspecified