Provider Demographics
NPI:1992243323
Name:BONHAM, JORDAN (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BONHAM
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 1:8928 US 70 BUS HWY W
Mailing Address - Street 2:STE 700
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4847
Mailing Address - Country:US
Mailing Address - Phone:919-553-5505
Mailing Address - Fax:919-553-5509
Practice Address - Street 1:8928 US 70 BUS HWY W
Practice Address - Street 2:SUITE 700
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4844
Practice Address - Country:US
Practice Address - Phone:919-553-5505
Practice Address - Fax:919-553-5509
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor