Provider Demographics
NPI:1609880657
Name:GORMAN, MICHAEL ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALBERT
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 1:636 LINCOLN HWY
Mailing Address - Street 2:10
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-1416
Mailing Address - Country:US
Mailing Address - Phone:215-943-2584
Mailing Address - Fax:215-943-3514
Practice Address - Street 1:636 LINCOLN HWY
Practice Address - Street 2:10
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1416
Practice Address - Country:US
Practice Address - Phone:215-943-2584
Practice Address - Fax:215-943-3514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088663Medicare UPIN