Healthcare Provider Details

I. General information

NPI: 1760418248
Provider Name (Legal Business Name): CORRECTIVE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 PARK PL W SUITE #200
MISHAWAKA IN
46545-3513
US

IV. Provider business mailing address

3555 PARK PL W SUITE #200
MISHAWAKA IN
46545-3513
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-8646
  • Fax: 574-271-8624
Mailing address:
  • Phone: 574-271-8646
  • Fax: 574-271-8624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number204D00000X
License Number StateIN

VIII. Authorized Official

Name: DR. MARK CANTIERI
Title or Position: C.E.O.
Credential: D.O.
Phone: 574-271-8646