Provider Demographics
NPI:1124236625
Name:GORDON J BRAUN DC PA
Entity type:Organization
Organization Name:GORDON J BRAUN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-864-1419
Mailing Address - Street 1:1175 71ST STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3645
Mailing Address - Country:US
Mailing Address - Phone:305-864-1419
Mailing Address - Fax:305-861-7246
Practice Address - Street 1:1175 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3645
Practice Address - Country:US
Practice Address - Phone:305-864-1419
Practice Address - Fax:305-861-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty