Provider Demographics
NPI:1770786030
Name:GORDACAN, KIMBERLY RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RUTH
Last Name:GORDACAN
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 1:2050 W STEELE LN STE A2
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3402
Mailing Address - Country:US
Mailing Address - Phone:707-571-0393
Mailing Address - Fax:707-571-0320
Practice Address - Street 1:2050 W STEELE LN STE A2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3402
Practice Address - Country:US
Practice Address - Phone:707-571-0393
Practice Address - Fax:707-571-0320
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17362111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology