Provider Demographics
NPI:1467442509
Name:STAFF, GORDON ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ARTHUR
Last Name:STAFF
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 1:6200 EXCELSIOR BOULEVARD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2734
Mailing Address - Country:US
Mailing Address - Phone:952-925-4639
Mailing Address - Fax:952-925-2404
Practice Address - Street 1:6200 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2730
Practice Address - Country:US
Practice Address - Phone:952-925-4639
Practice Address - Fax:952-925-2404
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1778111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66167Medicare UPIN