Provider Demographics
NPI:1366461006
Name:GORDON, ANNE I (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:I
Last Name:GORDON
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 1:30 S MICHIGAN AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3211
Mailing Address - Country:US
Mailing Address - Phone:312-726-1353
Mailing Address - Fax:312-726-5238
Practice Address - Street 1:30 S MICHIGAN AVE
Practice Address - Street 2:STE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3211
Practice Address - Country:US
Practice Address - Phone:312-726-1353
Practice Address - Fax:312-726-5238
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL959750Medicare ID - Type Unspecified
ILU26330Medicare UPIN