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General NPI Number Information
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NPI Number | 1477704484
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Entity Type | Organization
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Legal Business Name | BRYAN D. GORDON P.C.
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 2618 W 7800 S STE 200
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City | WEST JORDAN
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State | UT
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Zip | 84088-4208
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Country | US
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Telephone | 801-562-1531
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95928
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN GORDON
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Credential |
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Telephone | 801-562-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2774306-1202
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License Number State | UT
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