Healthcare Provider Details

I. General information

NPI: 1114970860
Provider Name (Legal Business Name): ROBERT KEITH MCCORMICK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 OLD AMHERST RD
BELCHERTOWN MA
01007-9745
US

IV. Provider business mailing address

145 OLD AMHERST RD
BELCHERTOWN MA
01007-9745
US

V. Phone/Fax

Practice location:
  • Phone: 413-253-9777
  • Fax: 413-253-7290
Mailing address:
  • Phone: 413-253-9777
  • Fax: 413-253-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number717
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4101
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: