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Individual
BRYAN GORDON
Active
Individual
BRYAN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2774306-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27743061202001
REGENCE BLUE CROSS NUMBER
UT
Enumeration date
11/16/2006
Last updated
07/08/2007
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