Provider Demographics
NPI:1528446135
Name:JORDAN, AMANDA LORIEN (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LORIEN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LORIEN
Other - Last Name:MUSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:103 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2476
Mailing Address - Country:US
Mailing Address - Phone:276-628-8167
Mailing Address - Fax:
Practice Address - Street 1:103 CHARWOOD DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2476
Practice Address - Country:US
Practice Address - Phone:276-628-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor