Provider Demographics
NPI:1336141480
Name:GORMLEY, MAUREEN E (DC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:E
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4124
Mailing Address - Country:US
Mailing Address - Phone:781-643-9433
Mailing Address - Fax:781-643-9433
Practice Address - Street 1:1250 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4124
Practice Address - Country:US
Practice Address - Phone:781-643-9433
Practice Address - Fax:781-643-9433
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35856Medicare ID - Type Unspecified