Provider Demographics
NPI:1568431468
Name:GORMAN, LOURDES G (DC)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:G
Last Name:GORMAN
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:PO BOX 69040
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737
Mailing Address - Country:US
Mailing Address - Phone:520-742-7336
Mailing Address - Fax:520-742-9126
Practice Address - Street 1:7520 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-742-7336
Practice Address - Fax:520-742-9124
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U16768Medicare UPIN
AZDC4439Medicare ID - Type Unspecified