Provider Demographics
NPI:1568685709
Name:GORDON, ELLIS FRANCIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:FRANCIS
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 1:2048 W 5400 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1428
Mailing Address - Country:US
Mailing Address - Phone:801-968-5400
Mailing Address - Fax:801-968-5405
Practice Address - Street 1:2048 W 5400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-1428
Practice Address - Country:US
Practice Address - Phone:801-968-5400
Practice Address - Fax:801-968-5405
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362371-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor