Provider Demographics
NPI:1528320082
Name:GORMAN, DUSTIN DAVID (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:DAVID
Last Name:GORMAN
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 1:3475 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50249-7574
Mailing Address - Country:US
Mailing Address - Phone:515-460-2256
Mailing Address - Fax:
Practice Address - Street 1:204 N US HIGHWAY 69 # B
Practice Address - Street 2:
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-9334
Practice Address - Country:US
Practice Address - Phone:515-460-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor