MEDICARE: DANIEL STEVEN GORDON D.C.

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	2301008121	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F32220	OTHER	MI	BC/BS

General Provider Information

NPI Number	:	1952416240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL STEVEN GORDON D.C.

Provider Business Mailing Address
First Line	:	7887 COOLEY LAKE RD
Second Line	:	STE 120
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3531
Country	:	US
Telephone Number	:	248-366-3300
Fax Number	:	248-366-3396

Provider Business Practice Location Address
First Line	:	7887 COOLEY LAKE RD
Second Line	:	STE 120
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3531
Country	:	US
Telephone Number	:	248-366-3300
Fax Number	:	248-366-3396

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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