Provider Demographics
NPI:1528087822
Name:GORMAN, GARY M (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:116 PLEASANT ST
Mailing Address - Street 2:STE 125
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2739
Mailing Address - Country:US
Mailing Address - Phone:413-789-6800
Mailing Address - Fax:413-789-5171
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1838
Practice Address - Country:US
Practice Address - Phone:413-789-6800
Practice Address - Fax:413-789-5171
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35611Medicare PIN