Provider Demographics
NPI:1245323146
Name:MCCORMICK, EDWARD GARLAND (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:GARLAND
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 1:227 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3475
Mailing Address - Country:US
Mailing Address - Phone:304-469-3615
Mailing Address - Fax:304-469-3652
Practice Address - Street 1:227 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3475
Practice Address - Country:US
Practice Address - Phone:304-469-3615
Practice Address - Fax:304-469-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004629Medicaid
WV3810004629Medicaid
WVV07645Medicare UPIN