Provider Demographics
NPI:1124522958
Name:JORDAN ORIENTAL MEDICINE, LLC
Entity type:Organization
Organization Name:JORDAN ORIENTAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:B M
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MSOM, DIPLAC
Authorized Official - Phone:480-350-7532
Mailing Address - Street 1:104 S. STELLAR PARK WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-8522
Mailing Address - Country:US
Mailing Address - Phone:480-350-7532
Mailing Address - Fax:
Practice Address - Street 1:104 S. STELLAR PARK WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-8522
Practice Address - Country:US
Practice Address - Phone:480-350-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0101261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center