Provider Demographics
NPI:1306883103
Name:GORDON CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:GORDON CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FREESEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-282-1154
Mailing Address - Street 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1277
Mailing Address - Country:US
Mailing Address - Phone:308-282-1154
Mailing Address - Fax:308-282-1156
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1277
Practice Address - Country:US
Practice Address - Phone:308-282-1154
Practice Address - Fax:308-282-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD988111N00000X
NE1186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-01Medicaid
SD=========Medicaid