Healthcare Provider Details

I. General information

NPI: 1346552601
Provider Name (Legal Business Name): GORKO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21050 N TATUM BLVD SUITE 202
PHOENIX AZ
85050-4260
US

IV. Provider business mailing address

21050 N TATUM BLVD SUITE 202
PHOENIX AZ
85050-4260
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-1600
  • Fax: 480-515-5444
Mailing address:
  • Phone: 602-788-1600
  • Fax: 480-515-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5212
License Number StateAZ

VIII. Authorized Official

Name: RAMSEY D GORDON
Title or Position: PRESIDENT / SECRETARY
Credential: D.C.
Phone: 602-788-1600