Individual
DR. JORDAN WILLIAM PONTIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, ATC
Contact information
Practice address
630 TERRA WEST DR, FREEPORT, IL 61032
(815) 235-7858
(815) 235-7913
Mailing address
627 N GREENFIELD DR, FREEPORT, IL 61032-2914
(815) 990-5394
(815) 235-7913
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038.013188
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6217986
AENTA
IL
01
—
765879632
BCBS
IL
Enumeration date
02/09/2018
Last updated
10/31/2019
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