Provider Demographics
NPI:1326071143
Name:GORDON L. RODETSKY
Entity Type:Organization
Organization Name:GORDON L. RODETSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-833-2600
Mailing Address - Street 1:2705 TAMIAMI TRL
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6987
Mailing Address - Country:US
Mailing Address - Phone:941-833-2600
Mailing Address - Fax:941-833-2603
Practice Address - Street 1:2705 TAMIAMI TRL UNIT 215
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6988
Practice Address - Country:US
Practice Address - Phone:941-833-2600
Practice Address - Fax:941-833-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98979OtherBCBSF
FLK6849Medicare ID - Type Unspecified