Provider Demographics
NPI:1356333447
Name:GORDLEY, MEGAN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:GORDLEY
Suffix:
Gender:F
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:N110 BRUX RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-9439
Mailing Address - Country:US
Mailing Address - Phone:920-968-0464
Mailing Address - Fax:920-968-0482
Practice Address - Street 1:559 EDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2358
Practice Address - Country:US
Practice Address - Phone:406-862-8080
Practice Address - Fax:406-862-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4674-12111N00000X
MT1087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01877Medicare UPIN