Provider Demographics
NPI:1447544820
Name:GORDON, MATTHEW DAVID (DC , MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:GORDON
Suffix:
Gender:M
Credentials:DC , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:79 HILLSDALE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1208
Mailing Address - Country:US
Mailing Address - Phone:517-439-9800
Mailing Address - Fax:517-439-1230
Practice Address - Street 1:79 HILLSDALE ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1208
Practice Address - Country:US
Practice Address - Phone:517-439-9800
Practice Address - Fax:517-439-1230
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC06053008Medicare PIN