Provider Demographics
NPI:1033376512
Name:MCCORMICK CHIROPRACTIC OF ELVERSON, PLLC
Entity Type:Organization
Organization Name:MCCORMICK CHIROPRACTIC OF ELVERSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-286-7000
Mailing Address - Street 1:83 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9491
Mailing Address - Country:US
Mailing Address - Phone:610-286-7000
Mailing Address - Fax:610-286-7003
Practice Address - Street 1:83 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9491
Practice Address - Country:US
Practice Address - Phone:610-286-7000
Practice Address - Fax:610-286-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003530L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMC164972Medicare UPIN