Provider Demographics
NPI:1114970860
Name:MCCORMICK, ROBERT KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:MCCORMICK
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 1:145 OLD AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9745
Mailing Address - Country:US
Mailing Address - Phone:413-253-9777
Mailing Address - Fax:413-253-7290
Practice Address - Street 1:145 OLD AMHERST RD
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9745
Practice Address - Country:US
Practice Address - Phone:413-253-9777
Practice Address - Fax:413-253-7290
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA717111N00000X
CO4101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3111330OtherAETNA
MA1610465Medicaid
MA792341OtherTUFTS
MAY35502OtherBCBS
MA1610465Medicaid
T58214Medicare UPIN
MAY35502Medicare ID - Type Unspecified