Healthcare Provider Details

I. General information

NPI: 1528087822
Provider Name (Legal Business Name): GARY M. GORMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
AGAWAM MA
01001-1838
US

IV. Provider business mailing address

116 PLEASANT ST STE 125
EASTHAMPTON MA
01027-2739
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-6800
  • Fax: 413-789-5171
Mailing address:
  • Phone: 413-789-6800
  • Fax: 413-789-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number850
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: