Organization
MCCORMACK CHIROPRACTIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGAN MCCORMACK DC (VICE PRESIDENT)
(262) 306-9775
Entity
Organization
Contact information
Practice address
519 SHEPHERDS DR, WEST BEND, WI 53090-8488
(262) 306-9775
(262) 306-9183
Mailing address
519 SHEPHERDS DR, WEST BEND, WI 53090-8488
(262) 306-9775
(262) 306-9183
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3559012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38961400
—
WI
01
—
484231357001
BLUE CROSS
WI
Enumeration date
03/26/2007
Last updated
08/22/2020
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