Organization
GORMAN CHIROPRACTIC LIFE CENTERS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON R GORMAN DC (OWNER)
(570) 476-4100
Entity
Organization
Contact information
Practice address
21 CRYSTAL STREET, EAST STROUDSBURG, PA 18301
(570) 476-4100
(570) 476-7669
Mailing address
21CRYSTAL STREET, EAST STROUDSBURG, PA 18301
(570) 476-4100
(570) 476-7669
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC002838L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7710165
AETNA
PA
01
—
813927
FIRST PRIORITY
PA
Enumeration date
10/04/2006
Last updated
10/28/2009
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