Provider Demographics
NPI:1023762796
Name:GORTON, MEGAN (DC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GORTON
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 1:858 W SHELTON WAY
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7660
Mailing Address - Country:US
Mailing Address - Phone:907-441-9223
Mailing Address - Fax:
Practice Address - Street 1:8860 S REDWOOD RD UNIT 106
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9391
Practice Address - Country:US
Practice Address - Phone:907-441-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty