Provider Demographics
NPI:1346246287
Name:LOVETT, GORDON BRIAN (DC FIAMA)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:BRIAN
Last Name:LOVETT
Suffix:
Gender:M
Credentials:DC FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28469 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2512
Mailing Address - Country:US
Mailing Address - Phone:727-723-3888
Mailing Address - Fax:727-796-2888
Practice Address - Street 1:28469 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 402
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2512
Practice Address - Country:US
Practice Address - Phone:727-723-3888
Practice Address - Fax:727-796-2888
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2014-03-10
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
FLCH 8305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70077Medicare UPIN