Provider Demographics
NPI:1033176987
Name:WHETTON, GORDON RANDAL (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:RANDAL
Last Name:WHETTON
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 1:859 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4962
Mailing Address - Country:US
Mailing Address - Phone:801-393-8880
Mailing Address - Fax:801-393-8881
Practice Address - Street 1:859 WASHINGTON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4962
Practice Address - Country:US
Practice Address - Phone:801-393-8880
Practice Address - Fax:801-393-8881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176413-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT247OtherUNITED HEALTH CARE
UT93176413104001OtherREGENCE BLUE CROSS
UT113OtherGE WELLNESS
UTD5226Medicaid