Individual
JORDAN RILEY JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
223 FORKER BUILDING 534 WALLACE RD, AMES, IA 50011-0001
(515) 783-8297
Mailing address
2608 EAGLE POINT CT, DES MOINES, IA 50320-2838
(515) 783-8297
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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