Provider Demographics
NPI:1366050601
Name:PALMER, JORDAN W (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:W
Last Name:PALMER
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 1:10355 TEXAS HIGHWAY 154 S
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-7475
Mailing Address - Country:US
Mailing Address - Phone:214-692-6666
Mailing Address - Fax:469-587-8439
Practice Address - Street 1:185 EASTGATE PLZ
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2868
Practice Address - Country:US
Practice Address - Phone:254-412-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor