Most Relevant Information
Provider Data
| NPI Number: | 1003299827 |
| Provider Name: | JORDAN TICHENOR |
| Entity Type: | Individual |
| Taxonomy Code: | 1835I0206X |
| Specialty: | |
| License Number: | 77711 |
Most Important Dates
| Enumeration Date: | 06/30/2015 |
| Last Updated: | 05/07/2024 |
Provider Practice Location
400 E 3RD ST
DULUTH
MN
558051951
Practice Location Phone/Fax
| Phone: | 2187863737 |
| Fax: | 1872783282 |
Provider Mailing Location
400 E 3RD ST
DULUTH
MN
558051951
Provider Mailing Phone/Fax
| Phone: | 2187868895 |
| Fax: | 2187278328 |