Kenneth Wesley Jordan, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3056 Issued in SC

Practice address

705 North Fraser St
Georgetown, SC 29442-0958

Phone

(843) 235-0546

Fax

(843) 527-8353

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Island Breeze Chiropractic Inc

  • Chiropractor
  • Pawleys Island, SC
  • NPI 1427239698
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1902867252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 NORTH FRASER STREET",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294420958",
            "telephone_number": "843-235-0546",
            "fax_number": "843-527-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 NORTH FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294420958",
            "telephone_number": "843-235-0546",
            "fax_number": "843-527-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "KENNETH",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GCH507",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jay Thomas Johnson, DO
• Owen Cannon Johnson, O.D.
• Stephanie Susan Johnson, D.C.
• Heather Elizabeth Jones, PTA
• Tara Jones, LMSW
• Joseph and Berson LLC
• Joseph and Joseph P.a.
• John Anthony Joseph Jr., D.M.D.
• Timothy Joseph, D.M.D.
• Kelley R Johnson, LLC

• Chiropractor in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.