Provider Demographics
NPI:1205858362
Name:GORMISH CHIROPRACTIC & REHABILITATION, INC.
Entity Type:Organization
Organization Name:GORMISH CHIROPRACTIC & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-344-8883
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-0630
Mailing Address - Country:US
Mailing Address - Phone:814-344-8883
Mailing Address - Fax:814-344-8685
Practice Address - Street 1:1821 PLANK RD
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-0630
Practice Address - Country:US
Practice Address - Phone:814-344-8883
Practice Address - Fax:814-344-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2465-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA426639OtherHIGHMARK NUMBER
PA026122Medicare ID - Type UnspecifiedMEDICARE NUMBER