Provider Demographics
NPI:1871990622
Name:BAUMAN, JORDAN LEE (D,C)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:WATHENA
Mailing Address - State:KS
Mailing Address - Zip Code:66090-1268
Mailing Address - Country:US
Mailing Address - Phone:785-989-4404
Mailing Address - Fax:785-989-3167
Practice Address - Street 1:210 E SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:WATHENA
Practice Address - State:KS
Practice Address - Zip Code:66090-1268
Practice Address - Country:US
Practice Address - Phone:785-989-4404
Practice Address - Fax:785-989-3167
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor