Provider Demographics
NPI:1760418248
Name:CORRECTIVE CARE, P.C.
Entity Type:Organization
Organization Name:CORRECTIVE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-271-8646
Mailing Address - Street 1:3555 PARK PL W
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3513
Mailing Address - Country:US
Mailing Address - Phone:574-271-8646
Mailing Address - Fax:574-271-8624
Practice Address - Street 1:3555 PARK PL W
Practice Address - Street 2:SUITE #200
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3513
Practice Address - Country:US
Practice Address - Phone:574-271-8646
Practice Address - Fax:574-271-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN204D00000X204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000000104082OtherBLUE CROSS BLUE SHIELD
IN0000000104082OtherBLUE CROSS BLUE SHIELD