Provider Demographics
NPI:1053062331
Name:THARP, JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:THARP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 W RAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6221
Mailing Address - Country:US
Mailing Address - Phone:480-855-0557
Mailing Address - Fax:
Practice Address - Street 1:4910 W RAY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6221
Practice Address - Country:US
Practice Address - Phone:480-855-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor