Provider Demographics
NPI:1174694756
Name:GORRIE, DAVID RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:GORRIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 NEWPORT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-8030
Mailing Address - Country:US
Mailing Address - Phone:714-544-9789
Mailing Address - Fax:714-544-9792
Practice Address - Street 1:12721 NEWPORT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8030
Practice Address - Country:US
Practice Address - Phone:714-544-9789
Practice Address - Fax:714-544-9792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU34138Medicare UPIN
CADC20197Medicare ID - Type Unspecified