Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 4445 | TX |
NPI | 1225191448 |
---|---|
Provider Name | Lawrence Gordon |
First Address | Stafford, TX 77477-5828 |
Second Address | Houston, TX 77035-2952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |