Provider Demographics
NPI:1457524993
Name:NORTHWEST CHIROPRACTIC PHYSICIANS LLC
Entity Type:Organization
Organization Name:NORTHWEST CHIROPRACTIC PHYSICIANS LLC
Other - Org Name:LOURDES G. GORMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:G
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-742-7336
Mailing Address - Street 1:PO BOX 69040
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0009
Mailing Address - Country:US
Mailing Address - Phone:520-742-7336
Mailing Address - Fax:
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:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-742-7336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty