Provider Demographics
NPI:1083818538
Name:GORDON CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:GORDON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-366-3300
Mailing Address - Street 1:7887 COOLEY LAKE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3531
Mailing Address - Country:US
Mailing Address - Phone:248-366-3300
Mailing Address - Fax:248-366-3396
Practice Address - Street 1:7887 COOLEY LAKE RD
Practice Address - Street 2:STE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3531
Practice Address - Country:US
Practice Address - Phone:248-366-3300
Practice Address - Fax:248-366-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU79951Medicare UPIN
MIOM99590Medicare ID - Type Unspecified