Provider Demographics
NPI:1306917786
Name:GARVER, GORDON B (DC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:B
Last Name:GARVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BATTERSEA DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8405
Mailing Address - Country:US
Mailing Address - Phone:904-264-7366
Mailing Address - Fax:
Practice Address - Street 1:418 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4828
Practice Address - Country:US
Practice Address - Phone:904-264-7366
Practice Address - Fax:904-264-7571
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor