Provider Demographics
NPI:1417347618
Name:MCLORN, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:MCLORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N KINZIE PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1074
Mailing Address - Country:US
Mailing Address - Phone:312-929-6004
Mailing Address - Fax:
Practice Address - Street 1:511 N KINZIE PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1074
Practice Address - Country:US
Practice Address - Phone:312-929-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)