Provider Demographics
NPI:1124608476
Name:JOE, JORDAN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:JOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 FARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2802
Mailing Address - Country:US
Mailing Address - Phone:214-477-1348
Mailing Address - Fax:
Practice Address - Street 1:2221 FARRINGTON LN
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2802
Practice Address - Country:US
Practice Address - Phone:214-477-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program