Organization
BRIAN GORDON DC LAC ACUPUNCTURE PROFESSIONAL CORPORATION
Active
Other names
Active Care Spine Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN BERNARD GORDON DC, LAC (PRESIDENT)
(818) 386-8835
Entity
Organization
Contact information
Practice address
5363 BALBOA BLVD, SUITE #439, ENCINO, CA 91316-2805
(818) 401-3295
(818) 387-6142
Mailing address
5363 BALBOA BLVD STE 436, ENCINO, CA 91316-2840
(818) 386-8835
(818) 387-6142
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC-29620
CA
171100000X
Acupuncturist
AC-13010
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC29620
MEDICARE PTAN
CA
Enumeration date
06/06/2007
Last updated
06/17/2016
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