Healthcare Provider Details

I. General information

NPI: 1790871523
Provider Name (Legal Business Name): RAMSEY D GORDON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 N TATUM BLVD SUITE 1630-888
PHOENIX AZ
85050-4206
US

IV. Provider business mailing address

21001 N TATUM BLVD SUITE 1630-888
PHOENIX AZ
85050-4206
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-1600
  • Fax: 602-569-7001
Mailing address:
  • Phone: 602-788-1600
  • Fax: 602-569-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5212
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: