Provider Demographics
NPI:1689086290
Name:MCCORMICK, JAIMIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAIMIE
Middle Name:L
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JAIMIE
Other - Middle Name:L
Other - Last Name:OBORNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1620 LOCUST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1475
Mailing Address - Country:US
Mailing Address - Phone:816-561-1185
Mailing Address - Fax:
Practice Address - Street 1:1620 LOCUST ST STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1475
Practice Address - Country:US
Practice Address - Phone:816-561-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05581111N00000X
MO2014010985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor