MEDICARE: WILLIAM RICHARD MCCORMICK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	6458	TX
2	111NS0005X	Sports Physician Chiropractor	2219	NC

General Provider Information

NPI Number	:	1205920774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM RICHARD MCCORMICK D.C.

Provider Business Mailing Address
First Line	:	2612-A S. LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704
Country	:	US
Telephone Number	:	512-804-1100
Fax Number	:	512-804-1102

Provider Business Practice Location Address
First Line	:	2612-A S. LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704
Country	:	US
Telephone Number	:	512-804-1100
Fax Number	:	512-804-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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