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General NPI Number Information
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NPI Number | 1508304783
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Entity Type | Organization
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Legal Business Name | GORDON FAMILY CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 228 PONTE VEDRA PARK DR SUITE 800
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City | PONTE VEDRA
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State | FL
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Zip | 32082-6613
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Country | US
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Telephone | 904-418-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 228 PONTE VEDRA PARK DR SUITE 800
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City | PONTE VEDRA
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State | FL
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Zip | 32082-6613
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Country | US
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Telephone | 904-418-3937
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. WAYNE GORDON
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Credential | DC
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Telephone | 904-418-3937
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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 | CH9576
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License Number State | FL
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