Provider Demographics
NPI:1366290900
Name:NEWTON, JORDAN (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 SIX FORKS RD STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2983
Mailing Address - Country:US
Mailing Address - Phone:919-725-2202
Mailing Address - Fax:
Practice Address - Street 1:8816 SIX FORKS RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2983
Practice Address - Country:US
Practice Address - Phone:919-725-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty