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Individual
MR. MITCHELL MASON GORDON
Active
Individual
MR. MITCHELL MASON GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
000976
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050000976CT02
ANTHEM BLUE CROSS & BLUE
CT
01
—
720384
CTCARE
CT
Enumeration date
05/02/2007
Last updated
07/08/2007
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