Provider Demographics
NPI:1427485671
Name:JORDAN, THOMAS A (LAC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2630 BRANDT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7646
Mailing Address - Country:US
Mailing Address - Phone:724-935-4300
Mailing Address - Fax:724-935-4321
Practice Address - Street 1:2630 BRANDT SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090
Practice Address - Country:US
Practice Address - Phone:724-935-3400
Practice Address - Fax:724-935-4321
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000254L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist