Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4624 | SC |
NPI | 1629669312 |
---|---|
Provider Name | Dr. Michael Gormley |
First Address | Piedmont, SC 29673-8185 |
Second Address | Greenville, SC 29615-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 27/01/2021 |