Individual
JORDAN R DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
404 N JOHN F KENNEDY AVE, LOOGOOTEE, IN 47553-1219
(812) 295-5600
(812) 295-5700
Mailing address
407 E MAIN ST, LOOGOOTEE, IN 47553-1241
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002579A
IN
Other
Enumeration date
04/11/2011
Last updated
06/28/2011
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