Provider Demographics
NPI:1326100280
Name:CORMIER, CEVIN CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CEVIN
Middle Name:CHARLES
Last Name:CORMIER
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 1:6300 AIRPORT BLVD
Mailing Address - Street 2:C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3161
Mailing Address - Country:US
Mailing Address - Phone:251-343-9990
Mailing Address - Fax:251-343-9181
Practice Address - Street 1:6300 AIRPORT BLVD
Practice Address - Street 2:C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3161
Practice Address - Country:US
Practice Address - Phone:251-343-9990
Practice Address - Fax:251-343-9181
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3099225100000X
AL1894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000021855OtherPTAN
AL510I650143OtherPTAN FOR PT
AL510I650143OtherPTAN FOR PT
AL000021855OtherPTAN
AL510G650003Medicare PIN