Provider Demographics
NPI:1710021654
Name:GORMLEY, JEAN A (DOM, AP, DC)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:A
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:DOM, AP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20844 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4061
Mailing Address - Country:US
Mailing Address - Phone:305-797-8527
Mailing Address - Fax:
Practice Address - Street 1:20844 4TH AVE W
Practice Address - Street 2:
Practice Address - City:CUDJOE KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4061
Practice Address - Country:US
Practice Address - Phone:305-797-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 751101Y00000X, 101YA0400X, 133N00000X, 171100000X, 175F00000X, 175L00000X, 225400000X, 225700000X
PADC002674L111NN1001X, 111NR0400X, 111NX0800X, 111N00000X, 111NR0400X
PAOM000012133N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist