Individual
JORDAN MATTHEW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
103 N 1ST ST, ELMA, WA 98541-9854
(360) 482-5155
Mailing address
PO BOX 656, ELMA, WA 98541-0656
(360) 482-5155
(360) 482-4155
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH60990272
WA
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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