Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CR1234 | ME |
N | 111NR0200X | Radiology | CR1234 | ME |
N | 213ER0200X | Radiology | CR1234 | ME |
NPI | 1205998002 |
---|---|
Provider Name | Jordan A Garlock |
First Address | Saco, ME 04072-9783 |
Second Address | Saco, ME 04072-9783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |