Provider Demographics
NPI:1699007559
Name:GORDON, SANDRA (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2809
Mailing Address - Country:US
Mailing Address - Phone:570-476-4100
Mailing Address - Fax:570-476-7669
Practice Address - Street 1:21 CRYSTAL ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2809
Practice Address - Country:US
Practice Address - Phone:570-476-4100
Practice Address - Fax:570-476-7669
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 10214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor