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General NPI Number Information
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NPI Number | 1477766038
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Entity Type | Individual
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Provider Name | JOHN GORDON KEPHART DC
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1905 ABRAMS RD
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City | DALLAS
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State | TX
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Zip | 75214-3916
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Country | US
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Telephone | 972-392-3400
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Fax | 972-392-3499
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Provider Business Mailing Address
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Address Line | 5517 MANASSAS DR
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City | ARLINGTON
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State | TX
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Zip | 76017-4982
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Country | US
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Telephone | 214-943-1948
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Fax | 214-943-0435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4053
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License Number State | TX
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