Provider Demographics
NPI:1295328490
Name:GORMAN, CALEB PAUL (DC)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:PAUL
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 1:113 W. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1109
Mailing Address - Country:US
Mailing Address - Phone:636-938-9310
Mailing Address - Fax:636-938-3204
Practice Address - Street 1:113 W. 5TH ST.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1109
Practice Address - Country:US
Practice Address - Phone:636-938-9310
Practice Address - Fax:636-938-3204
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor