# JORDAN SPINE & REHAB CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669120796
- **Authorized official:** DR. LAUREN MICHELLE JORDAN DC (CHIROPRACTOR)
- **Authorized official phone:** (309) 431-2357

## Contact information

- **Practice address:** 4 YOUNT DR STE 4, BLOOMINGTON, IL 61704-3737
- **Practice address phone:** (309) 431-2357
- **Mailing address:** 307 BEACON CIR, BLOOMINGTON, IL 61704-1442
- **Mailing address phone:** (309) 531-9374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/17/2022
- **Last updated:** 03/17/2022