Provider Demographics
NPI:1053705780
Name:PIERCE, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CRYSTAL ST
Mailing Address - Street 2:APPT 205
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 CRYSTAL ST
Practice Address - Street 2:APPT 205
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8318
Practice Address - Country:US
Practice Address - Phone:515-360-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer