Provider Demographics
NPI:1477766038
Name:KEPHART, JOHN GORDON (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GORDON
Last Name:KEPHART
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 1:5517 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4982
Mailing Address - Country:US
Mailing Address - Phone:214-943-1948
Mailing Address - Fax:214-943-0435
Practice Address - Street 1:1905 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3916
Practice Address - Country:US
Practice Address - Phone:972-392-3400
Practice Address - Fax:972-392-3499
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor