Provider Demographics
NPI:1861925406
Name:REVORD, LANDON (DC)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:
Last Name:REVORD
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 1:913 E PICKARD ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1095
Mailing Address - Country:US
Mailing Address - Phone:989-372-0003
Mailing Address - Fax:989-393-6009
Practice Address - Street 1:913 E PICKARD ST
Practice Address - Street 2:SUITE N
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1095
Practice Address - Country:US
Practice Address - Phone:989-372-0003
Practice Address - Fax:989-393-6009
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor