Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 104556955 | VA |
N | 111NR0400X | Rehabilitation Chiropractor | S03691 | MD |
NPI | 1245505544 |
---|---|
Provider Name | Jordan Speares |
First Address | Manakin Sabot, VA 23103-2272 |
Second Address | Manakin Sabot, VA 23103-2272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 11/05/2021 |