Provider Demographics
NPI:1942047642
Name:CORDON, JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:CORDON
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 1:4766 PARK GRANADA UNIT 206A
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1546
Mailing Address - Country:US
Mailing Address - Phone:818-233-0291
Mailing Address - Fax:
Practice Address - Street 1:4766 PARK GRANADA UNIT 206A
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1546
Practice Address - Country:US
Practice Address - Phone:818-233-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36537111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports Physician