Provider Demographics
NPI:1023637659
Name:REIZER, JORDAN THOMAS I (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:THOMAS
Last Name:REIZER
Suffix:I
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 1:1005 ALICE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2445
Mailing Address - Country:US
Mailing Address - Phone:732-581-5993
Mailing Address - Fax:
Practice Address - Street 1:11 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4315
Practice Address - Country:US
Practice Address - Phone:732-581-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor