Active NPI
Craig Logan Jordan, DR OF CHIROPRACTIC
- Chiropractor
- West Allis, WI
National Provider Identifier
1467521328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1341012
- Practice address
- 10817 W Lincoln Ave
West Allis, WI 53227-1127 - Phone
- (414) 327-6767
- Fax
- (414) 327-0988
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1341012 | WI | Primary |
Addresses
Primary practice location
10817 W Lincoln Ave
West Allis, WI 53227-1127
Mailing address
10817 W Lincoln Ave
West Allis, WI 53227-1127
Phone (414) 327-6767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1341012 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296086400000",
"number": "1467521328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10817 W LINCOLN AVE",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532271127",
"telephone_number": "414-327-6767",
"fax_number": "414-327-0988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10817 W LINCOLN AVE",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532271127",
"telephone_number": "414-327-6767",
"fax_number": "414-327-0988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "CRAIG",
"middle_name": "LOGAN",
"credential": "DR OF CHIROPRACTIC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2011-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "1341012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.