Provider Demographics
NPI:1659422806
Name:CORMIER, JAMES MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
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 1:114 MERRIAM AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3175
Mailing Address - Country:US
Mailing Address - Phone:978-345-1224
Mailing Address - Fax:978-345-1418
Practice Address - Street 1:114 MERRIAM AVE STE 202
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3175
Practice Address - Country:US
Practice Address - Phone:978-345-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH-1855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA41500OtherHPHC MA
MA791471OtherTUFTS HEALTH PLAN
MAY36330OtherBCBS MA
MAU54377Medicare UPIN
MA791471OtherTUFTS HEALTH PLAN