Provider Demographics
NPI:1720450489
Name:TENNANT, JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:TENNANT
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 1:1855 E GUADALUPE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3269
Mailing Address - Country:US
Mailing Address - Phone:480-839-8552
Mailing Address - Fax:
Practice Address - Street 1:1855 E GUADALUPE RD STE 112
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3269
Practice Address - Country:US
Practice Address - Phone:480-839-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor