Provider Demographics
NPI:1285073379
Name:JORDAN, ELLIOTT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:JAMES
Last Name:JORDAN
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 1:535 W CORNELIA AVE APT 802
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2707
Mailing Address - Country:US
Mailing Address - Phone:330-423-2060
Mailing Address - Fax:
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3581
Practice Address - Country:US
Practice Address - Phone:630-668-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor