Basic Information
| Provider Information | |||||||||
| NPI: | 1114970860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 145 OLD AMHERST RD | ||||||||
| Address2: | |||||||||
| City: | BELCHERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010079745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132539777 | ||||||||
| FaxNumber: | 4132537290 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 OLD AMHERST RD | ||||||||
| Address2: | |||||||||
| City: | BELCHERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010079745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132539777 | ||||||||
| FaxNumber: | 4132537290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 717 | MA | Y | Chiropractic Providers | Chiropractor | 111N00000X | 4101 | CO | N | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 3111330 | 01 | MA | AETNA | OTHER | 1610465 | 05 | MA | MEDICAID | 792341 | 01 | MA | TUFTS | OTHER | Y35502 | 01 | MA | BCBS | OTHER |