Healthcare Provider Details

I. General information

NPI: 1356561013
Provider Name (Legal Business Name): CORMIER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3697
US

IV. Provider business mailing address

4432 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3697
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0008
  • Fax: 480-945-2778
Mailing address:
  • Phone: 480-945-0008
  • Fax: 480-945-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5685
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL D CORMIER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-945-0008