Provider Demographics
NPI:1174726657
Name:MCCORMICK CHIROPRACTIC CO., LLC
Entity type:Organization
Organization Name:MCCORMICK CHIROPRACTIC CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER 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:610-705-0201
Mailing Address - Street 1:92 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7639
Mailing Address - Country:US
Mailing Address - Phone:610-705-0201
Mailing Address - Fax:610-705-0180
Practice Address - Street 1:92 KEMP RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7639
Practice Address - Country:US
Practice Address - Phone:610-705-0201
Practice Address - Fax:610-705-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0085995000Medicare UPIN
PA555138Medicare UPIN