Provider Demographics
NPI:1891335832
Name:MCCORMICK, BRANDON PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PATRICK
Last Name:MCCORMICK
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 1:3510 GALLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4353
Mailing Address - Country:US
Mailing Address - Phone:262-758-4932
Mailing Address - Fax:
Practice Address - Street 1:3510 GALLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4353
Practice Address - Country:US
Practice Address - Phone:262-758-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor