MEDICARE: DR. PAUL J GORDON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1288	LA

General Provider Information

NPI Number	:	1013050749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J GORDON DC

Provider Business Mailing Address
First Line	:	69150 HIGHWAY 190 SERVICE RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-778-2036
Fax Number	:	844-674-7170

Provider Business Practice Location Address
First Line	:	69150 HIGHWAY 190 SERVICE RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-778-2036
Fax Number	:	844-674-7170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/17/2023

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