Provider Demographics
NPI:1932235561
Name:MCCORMICK, JUSTIN KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KEITH
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 1:15224 MAIN ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7316
Mailing Address - Country:US
Mailing Address - Phone:425-379-9749
Mailing Address - Fax:
Practice Address - Street 1:15224 MAIN ST
Practice Address - Street 2:STE. 103
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7316
Practice Address - Country:US
Practice Address - Phone:425-379-9749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor