Healthcare Provider Details

I. General information

NPI: 1114920725
Provider Name (Legal Business Name): GORDON B BYRNE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PETRO PL STE 2
GIRARD OH
44420-3123
US

IV. Provider business mailing address

1 PETRO PL STE 2
GIRARD OH
44420-3123
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-8170
  • Fax: 330-545-5917
Mailing address:
  • Phone: 330-545-8170
  • Fax: 330-545-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2576
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: