Provider Demographics
NPI:1306818117
Name:GORDON, DOUGLAS JON (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JON
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 1:5466 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4183
Mailing Address - Country:US
Mailing Address - Phone:269-979-2000
Mailing Address - Fax:269-979-8630
Practice Address - Street 1:5466 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4183
Practice Address - Country:US
Practice Address - Phone:269-979-2000
Practice Address - Fax:269-979-8630
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor