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General NPI Number Information
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NPI Number | 1699751149
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Entity Type | Organization
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Legal Business Name | THOMAS H GORMAN DC PC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 440 ARSENAL ST
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City | WATERTOWN
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State | MA
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Zip | 02472-2898
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Country | US
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Telephone | 617-926-0202
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Fax | 617-926-5430
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Provider Business Mailing Address
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Address Line | 440 ARSENAL ST
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City | WATERTOWN
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State | MA
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Zip | 02472-2898
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Country | US
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Telephone | 617-926-0202
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Fax | 617-926-5430
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS H GORMAN
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Credential | DC
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Telephone | 617-926-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 964
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License Number State | MA
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