Provider Demographics
NPI:1417483884
Name:SOSSONG, JORDAN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAEL
Last Name:SOSSONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SW 16TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1228
Mailing Address - Country:US
Mailing Address - Phone:352-351-3413
Mailing Address - Fax:
Practice Address - Street 1:1009 SW 16TH LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1228
Practice Address - Country:US
Practice Address - Phone:352-351-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2024-12-04
Deactivation Date:2024-08-26
Deactivation Code:
Reactivation Date:2024-12-03
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL15148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician