Provider Demographics
NPI:1619388873
Name:GORDON, CAITLIN (DAC)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 30TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1236
Mailing Address - Country:US
Mailing Address - Phone:303-997-8746
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 205
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1236
Practice Address - Country:US
Practice Address - Phone:303-997-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist