Provider Demographics
NPI:1265754295
Name:DR. GORDON A STEVENSON CHIROPRACTOR, INC.
Entity type:Organization
Organization Name:DR. GORDON A STEVENSON CHIROPRACTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-244-9092
Mailing Address - Street 1:101 PASS RUN RD.
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835
Mailing Address - Country:US
Mailing Address - Phone:540-244-9092
Mailing Address - Fax:
Practice Address - Street 1:101 PASS RUN DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-3529
Practice Address - Country:US
Practice Address - Phone:540-244-9092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty