Provider Demographics
NPI:1043597172
Name:GORDON, JAMES O (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:GORDON
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 1:2172 ST. STEPHENS RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617
Mailing Address - Country:US
Mailing Address - Phone:251-476-7246
Mailing Address - Fax:251-457-7437
Practice Address - Street 1:2172 SAINT STEPHENS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-3703
Practice Address - Country:US
Practice Address - Phone:251-476-7246
Practice Address - Fax:251-457-7437
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor