Healthcare Provider Details

I. General information

NPI: 1306883103
Provider Name (Legal Business Name): GORDON CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N MAIN ST
GORDON NE
69343-1277
US

IV. Provider business mailing address

229 N MAIN ST
GORDON NE
69343-1277
US

V. Phone/Fax

Practice location:
  • Phone: 308-282-1154
  • Fax: 308-282-1156
Mailing address:
  • Phone: 308-282-1154
  • Fax: 308-282-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number988
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1186
License Number StateNE

VIII. Authorized Official

Name: MR. JOHN TODD FREESEMAN
Title or Position: PRESIDENT/EXECUTIVE OFFICER
Credential: D.C.
Phone: 308-282-1154