MEDICARE: DR. RAMSEY D 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	111N00000X	Chiropractor	5212	AZ
2	111NR0400X	Rehabilitation Chiropractor	2937	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	860827817	OTHER	AZ	FEDERAL TAZ ID#
2	AZ0242530	OTHER	AZ	BCBS #
3	5212	OTHER	AZ	AZ LICENCE#

General Provider Information

NPI Number	:	1790871523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMSEY D GORDON D.C.

Provider Business Mailing Address
First Line	:	21001 N TATUM BLVD
Second Line	:	SUITE 1630-888
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4206
Country	:	US
Telephone Number	:	602-788-1600
Fax Number	:	602-569-7001

Provider Business Practice Location Address
First Line	:	21001 N TATUM BLVD
Second Line	:	SUITE 1630-888
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4206
Country	:	US
Telephone Number	:	602-788-1600
Fax Number	:	602-569-7001

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/19/2012

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