Provider Demographics
NPI:1669559258
Name:EATMAN, GORDON BATTLE (DC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:BATTLE
Last Name:EATMAN
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 1:49 LOS LOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9308
Mailing Address - Country:US
Mailing Address - Phone:505-286-8067
Mailing Address - Fax:505-286-8067
Practice Address - Street 1:49 LOS LOMAS CIR
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9308
Practice Address - Country:US
Practice Address - Phone:505-286-8067
Practice Address - Fax:505-286-8067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K6164Medicaid
NM2671864Medicare ID - Type Unspecified