Provider Demographics
NPI:1356561013
Name:CORMIER CHIROPRACTIC
Entity type:Organization
Organization Name:CORMIER CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-945-0008
Mailing Address - Street 1:4432 N MILLER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3697
Mailing Address - Country:US
Mailing Address - Phone:480-945-0008
Mailing Address - Fax:480-945-2778
Practice Address - Street 1:4432 N MILLER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3697
Practice Address - Country:US
Practice Address - Phone:480-945-0008
Practice Address - Fax:480-945-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5685111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ82570Medicare ID - Type UnspecifiedMEDICARE GROUP #
AZ82776Medicare ID - Type UnspecifiedDR. CORMIER INDIVIDUAL #
AZU74268Medicare UPIN