Provider Demographics
NPI:1518092089
Name:GORDON, GREGORY JOHN (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:GORDON
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 1:1494 S. ARLINGTON RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306
Mailing Address - Country:US
Mailing Address - Phone:330-786-9861
Mailing Address - Fax:330-786-9862
Practice Address - Street 1:1494 S ARLINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3832
Practice Address - Country:US
Practice Address - Phone:330-786-9861
Practice Address - Fax:330-786-9862
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor