Provider Demographics
NPI:1508952557
Name:CHEYNE, GORDON GREGORY (DC)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:GREGORY
Last Name:CHEYNE
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 1:5050 S 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4923
Mailing Address - Country:US
Mailing Address - Phone:772-468-8891
Mailing Address - Fax:772-468-7929
Practice Address - Street 1:5050 S 25TH STREET
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4923
Practice Address - Country:US
Practice Address - Phone:772-468-8891
Practice Address - Fax:772-468-7929
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor