Provider Demographics
NPI:1922021732
Name:GORMISH, CLAY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:ANDREW
Last Name:GORMISH
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-2465-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010775490001Medicaid
PA427157M7QMedicare ID - Type UnspecifiedMEDICARE NUMBER
PA427157Medicare UPIN