Provider Demographics
NPI:1366789802
Name:DOI, JORDAN (MSC, DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DOI
Suffix:
Gender:M
Credentials:MSC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 NW YORK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-388-2429
Mailing Address - Fax:541-388-2439
Practice Address - Street 1:629 NW YORK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-388-2429
Practice Address - Fax:541-388-2439
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5104OtherOREGON STATE LICENSE NUMBER