Provider Demographics
NPI:1659322782
Name:MCCORMACK, DENNIS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:MCCORMACK
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 1:49196 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1120
Mailing Address - Country:US
Mailing Address - Phone:734-667-2012
Mailing Address - Fax:
Practice Address - Street 1:1716 S LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1108
Practice Address - Country:US
Practice Address - Phone:734-394-0771
Practice Address - Fax:734-394-2528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM2301005936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI617443OtherACN
MICH820019OtherMCARE
MI112371OtherPREFERRED CARE CHOICES
MI3296688Medicaid
MI4800650OtherCIGNA
MIU34337Medicare UPIN
MI3296688Medicaid