Provider Demographics
NPI:1588650212
Name:ELDER, GORDON DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:DAVID
Last Name:ELDER
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 1:1212 AVENUE J STE 101
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4020
Mailing Address - Country:US
Mailing Address - Phone:806-747-2735
Mailing Address - Fax:806-702-4927
Practice Address - Street 1:1212 AVENUE J STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4020
Practice Address - Country:US
Practice Address - Phone:806-747-2735
Practice Address - Fax:806-702-4927
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13601111N00000X
CADC26711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26711Medicare PIN
CAU84194Medicare UPIN