Individual
BRIAN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, LAC
Contact information
Practice address
5363 BALBOA BLVD, SUITE 436, ENCINO, CA 91316-2805
(818) 386-8835
Mailing address
5363 BALBOA BLVD STE 436, ENCINO, CA 91316-2840
(818) 386-8835
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
—
Enumeration date
12/21/2006
Last updated
06/17/2016
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