MEDICARE: LAWRENCE GORDON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	4445	TX

General Provider Information

NPI Number	:	1225191448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE GORDON D.C.

Provider Business Mailing Address
First Line	:	606 WHEELHOUSE DR
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-5828
Country	:	US
Telephone Number	:	713-729-6187
Fax Number	:	713-729-0668

Provider Business Practice Location Address
First Line	:	11431 CHIMNEY ROCK RD
Second Line	:	SUITE 3
City	:	HOUSTON
State	:	TX
Zip	:	77035-2952
Country	:	US
Telephone Number	:	713-729-6187
Fax Number	:	713-729-0668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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