Provider Demographics
NPI:1225191448
Name:GORDON, LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
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 1:606 WHEELHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5828
Mailing Address - Country:US
Mailing Address - Phone:713-729-6187
Mailing Address - Fax:713-729-0668
Practice Address - Street 1:11431 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2952
Practice Address - Country:US
Practice Address - Phone:713-729-6187
Practice Address - Fax:713-729-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4445111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation