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NPI Code Detail

MEDICARE: DR. KEYA M GORDON DC

MEDICARE: DR. KEYA M GORDON DC
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
1111N00000XChiropractor038.13385IL

General Provider Information

NPI Number : 1649832809
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEYA M GORDON DC
Provider Business Mailing Address
First Line : 16101 WEBER RD
Second Line :
City : CREST HILL
State : IL
Zip : 60403-8812
Country : US
Telephone Number : 615-818-6976
Fax Number :
Provider Business Practice Location Address
First Line : 225 W HUBBARD ST STE 302
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4916
Country : US
Telephone Number : 615-818-6976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2019
Last Update Date : 06/18/2020

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Directions to “ DR. KEYA M GORDON DC” Practice Location

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