Provider Demographics
NPI:1629146345
Name:GORMAN, RICHARD E (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 S GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5828
Mailing Address - Country:US
Mailing Address - Phone:541-484-6933
Mailing Address - Fax:541-484-1561
Practice Address - Street 1:388 S GARDEN WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5828
Practice Address - Country:US
Practice Address - Phone:541-484-6933
Practice Address - Fax:541-484-1561
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1313111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGBKLMedicare PIN
OR756350950Medicare PIN