Provider Demographics
NPI:1285136739
Name:JORDAN, JESSICA B M (PHD DIPL AC MSOM LAC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:B M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD DIPL AC MSOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JORDAN ORIENTAL MEDICINE, LLC
Mailing Address - Street 2:104 S STELLAR PARK WAY
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3725
Mailing Address - Country:US
Mailing Address - Phone:480-350-7532
Mailing Address - Fax:
Practice Address - Street 1:104 S STELLAR PKWY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3725
Practice Address - Country:US
Practice Address - Phone:480-350-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110171100000X
AZ0101171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist