Brian Gordon DC Lac Acupuncture Professional Corporation

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC-29620 Issued in CA

Legal business name

BRIAN GORDON DC LAC ACUPUNCTURE PROFESSIONAL CORPORATION

Doing business as

Active Care Spine Center

Practice address

5363 Balboa Blvd
Suite #439
Encino, CA 91316-2805

Phone

(818) 401-3295

Fax

(818) 387-6142

NPI assigned

Jun 6, 2007

Last updated

Jun 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian Bernard Gordon, DC, LACNPI 1750445821

Title

President

Phone

(818) 386-8835

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Active Care Spine Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Gordon, DC, LAC

  • Chiropractor
  • Encino, CA
  • NPI 1750445821
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1629271846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5363 BALBOA BLVD STE 436",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162840",
            "telephone_number": "818-386-8835",
            "fax_number": "818-387-6142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5363 BALBOA BLVD",
            "address_2": "SUITE #439",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162805",
            "telephone_number": "818-401-3295",
            "fax_number": "818-387-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN GORDON DC LAC ACUPUNCTURE PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-386-8835",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, LAC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC-29620",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC-13010",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "DC29620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Care Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Encino, CA
• Providers in Encino, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.