Healthcare Provider Details

I. General information

NPI: 1083964688
Provider Name (Legal Business Name): DAVID MCCORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 NORTH AVE
BATTLE CREEK MI
49017-3177
US

IV. Provider business mailing address

1018 NORTH AVE
BATTLE CREEK MI
49017-3177
US

V. Phone/Fax

Practice location:
  • Phone: 269-968-0888
  • Fax: 269-968-5975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003651
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: