Provider Demographics
NPI:1053435826
Name:AIKEN, GORDON LANTERMAN (DC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:LANTERMAN
Last Name:AIKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9012
Mailing Address - Country:US
Mailing Address - Phone:918-627-1100
Mailing Address - Fax:918-627-6504
Practice Address - Street 1:5802 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9012
Practice Address - Country:US
Practice Address - Phone:918-627-1100
Practice Address - Fax:918-627-6504
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
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