Provider Demographics
NPI:1679241319
Name:MCCORMICK CHIROPRACTIC MAIN LINE LLC
Entity Type:Organization
Organization Name:MCCORMICK CHIROPRACTIC MAIN LINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-705-0201
Mailing Address - Street 1:1199 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1341
Mailing Address - Country:US
Mailing Address - Phone:610-310-8659
Mailing Address - Fax:610-705-0180
Practice Address - Street 1:1199 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1341
Practice Address - Country:US
Practice Address - Phone:610-310-8659
Practice Address - Fax:610-705-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty