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General NPI Number Information
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NPI Number | 1649832809
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Entity Type | Individual
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Provider Name | KEYA M GORDON DC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 225 W HUBBARD ST STE 302
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City | CHICAGO
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State | IL
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Zip | 60654-4916
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Country | US
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Telephone | 615-818-6976
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Fax |
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Provider Business Mailing Address
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Address Line | 16101 WEBER RD
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City | CREST HILL
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State | IL
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Zip | 60403-8812
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Country | US
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Telephone | 615-818-6976
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Fax |
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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 | 038.13385
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License Number State | IL
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