MEDICARE: DR. MAUREEN E GORMLEY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1191	MA

General Provider Information

NPI Number	:	1336141480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN E GORMLEY D.C.

Provider Business Mailing Address
First Line	:	1250 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4124
Country	:	US
Telephone Number	:	781-643-9433
Fax Number	:	781-643-9433

Provider Business Practice Location Address
First Line	:	1250 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4124
Country	:	US
Telephone Number	:	781-643-9433
Fax Number	:	781-643-9433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/26/2008

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