Healthcare Provider Details

I. General information

NPI: 1538642335
Provider Name (Legal Business Name): GORDON WENDEL NEWELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 FAIRCOVE CIR
GARLAND TX
75043-6100
US

IV. Provider business mailing address

6417 FAIRCOVE CIR
GARLAND TX
75043-6100
US

V. Phone/Fax

Practice location:
  • Phone: 972-674-8684
  • Fax: 972-767-3389
Mailing address:
  • Phone: 972-674-8684
  • Fax: 972-767-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number13889
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: