Provider Demographics
NPI:1114290194
Name:MCCORMIC, RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:MCCORMIC
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 1:29970 SW TOWN CENTER LOOP W
Mailing Address - Street 2:STE C
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7429
Mailing Address - Country:US
Mailing Address - Phone:503-625-7755
Mailing Address - Fax:
Practice Address - Street 1:29970 SW TOWN CENTER LOOP W
Practice Address - Street 2:STE C
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7429
Practice Address - Country:US
Practice Address - Phone:503-625-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor