Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 021001986 | IL |
Y | 1223X0400X | Orthodontists | 1002704 | WI |
NPI | 1033266291 |
---|---|
Provider Name | Dr. Christopher N. Jordan |
First Address | Brookfield, WI 53008-1727 |
Second Address | Wauwatosa, WI 53222-3196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 01/11/2021 |