Provider Demographics
NPI:1316114556
Name:JORDAN, LINDSAY PRATT (LAC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:PRATT
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01144171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500608082Medicaid
OR9344442OtherCIGNA