Provider Demographics
NPI:1104324672
Name:POWELL, JORDAN S (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:POWELL
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 1:65 HATTON AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-6806
Mailing Address - Country:US
Mailing Address - Phone:318-771-5975
Mailing Address - Fax:
Practice Address - Street 1:2286 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5519
Practice Address - Country:US
Practice Address - Phone:541-484-5777
Practice Address - Fax:541-284-2704
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR6203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health