Kyle Gordon, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

11726657-1202 Issued in UT

Practice address

891 W Baxter Dr
South Jordan, UT 84095-8506

Phone

(509) 270-3687

NPI assigned

Apr 24, 2020

Last updated

Aug 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revive Health and Chiropractic Inc

  • Health Service Clinic/Center
  • South Jordan, UT
  • NPI 1336730217
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1407476849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 W BAXTER DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958506",
            "telephone_number": "509-270-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 W BAXTER DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958506",
            "telephone_number": "509-270-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-24",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "11726657-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Pierce Good, M.D.
• Teresa Diane Goodner, FNP
• John Goodson
• Bryce Goodwin
• Bryan Gordon, D.C.
• Courtney Marie Gormus, DNP, APRN, FNP-C
• Theresa Gourde, MD
• Grab Healthcare, LLC
• Grabmd, LLC
• Shannee June Graham, LAMFT

• Chiropractor in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.