Provider Demographics
NPI:1952416240
Name:GORDON, DANIEL STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:STEVEN
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 1:7887 COOLEY LAKE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3531
Mailing Address - Country:US
Mailing Address - Phone:248-366-3300
Mailing Address - Fax:248-366-3396
Practice Address - Street 1:7887 COOLEY LAKE RD
Practice Address - Street 2:STE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3531
Practice Address - Country:US
Practice Address - Phone:248-366-3300
Practice Address - Fax:248-366-3396
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F32220OtherBC/BS
MI0M99590Medicare ID - Type Unspecified
MI950F32220OtherBC/BS