Provider Demographics
NPI:1871580464
Name:KJOS, NEIL JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:JORDAN
Last Name:KJOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 CUMMINGS HWY
Mailing Address - Street 2:STE. 120
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2435
Mailing Address - Country:US
Mailing Address - Phone:423-825-5252
Mailing Address - Fax:423-825-1228
Practice Address - Street 1:3536 CUMMINGS HWY
Practice Address - Street 2:STE. 120
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2435
Practice Address - Country:US
Practice Address - Phone:423-825-5252
Practice Address - Fax:423-825-1228
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1430111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5011638OtherAETNA PIN
TN621713923OtherTAX ID NO.
GA350052346OtherRAILROAD MC/PALMETTO GBA
TN3069538OtherBLUE CROSS PIN
GA000933226AMedicaid
TNU68830Medicare UPIN
GA350052346OtherRAILROAD MC/PALMETTO GBA