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General NPI Number Information
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NPI Number | 1801425913
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Entity Type | Individual
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Provider Name | YALE GORDON DC
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 6263 PHILIPS HWY
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6047
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Country | US
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Telephone | 904-374-1339
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Fax |
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Provider Business Mailing Address
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Address Line | 8680 BAYMEADOWS RD E , JACKSONVILLE FL 32256 APT 722 8680 BAYMEADOWS RD E, JACKSONVILLE FL 32256 APT 722
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 908-463-3305
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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 | CH13083
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License Number State | FL
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