Provider Demographics
NPI:1639683626
Name:GORDON D. ELDER, D.C., P.A.
Entity Type:Organization
Organization Name:GORDON D. ELDER, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-747-2735
Mailing Address - Street 1:3410 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-1236
Mailing Address - Country:US
Mailing Address - Phone:806-747-2735
Mailing Address - Fax:
Practice Address - Street 1:3410 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-1236
Practice Address - Country:US
Practice Address - Phone:806-747-2735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty