Active NPI
Theresa Kathleen Gormly, CH
- Chiropractor
- Los Angeles, CA
National Provider Identifier
1265654149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC15936
- Practice address
- 1157 S Robertson Blvd
Los Angeles, CA 90035-1403 - Phone
- (310) 858-8886
- Fax
- (313) 858-1630
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC15936 | CA | Primary |
Addresses
Primary practice location
1157 S Robertson Blvd
Los Angeles, CA 90035-1403
Mailing address
1157 S Robertson Blvd
Los Angeles, CA 90035-1403
Phone (310) 858-8886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120525000310 | CA | Practitioner - Chiropractic | 4082877246 | Practice locations: Los Angeles, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1984
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1157 S Robertson Blvd
Los Angeles, CA 90035-1403
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC15936 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196726400000",
"number": "1265654149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1157 S ROBERTSON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900351403",
"telephone_number": "310-858-8886",
"fax_number": "313-858-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1157 S ROBERTSON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900351403",
"telephone_number": "310-858-8886",
"fax_number": "313-858-1630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORMLY",
"first_name": "THERESA",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "CH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC15936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.