Provider Demographics
NPI:1790871523
Name:GORDON, RAMSEY D (DC)
Entity Type:Individual
Prefix:DR
First Name:RAMSEY
Middle Name:D
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 1:21001 N TATUM BLVD
Mailing Address - Street 2:SUITE 1630-888
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:602-788-1600
Mailing Address - Fax:602-569-7001
Practice Address - Street 1:21001 N TATUM BLVD
Practice Address - Street 2:SUITE 1630-888
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4206
Practice Address - Country:US
Practice Address - Phone:602-788-1600
Practice Address - Fax:602-569-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5212111N00000X
AZ2937111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860827817OtherFEDERAL TAZ ID#
AZAZ0242530OtherBCBS #
AZ5212OtherAZ LICENCE#
AZAZ0242530OtherBCBS #
AZ5212OtherAZ LICENCE#