Healthcare Provider Details

I. General information

NPI: 1316114598
Provider Name (Legal Business Name): PHILIP MC CORMICK D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 SEDONA AVE
ROSAMOND CA
93560-6830
US

IV. Provider business mailing address

3116 SEDONA AVE
ROSAMOND CA
93560-6830
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-0629
  • Fax:
Mailing address:
  • Phone: 626-215-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: