Provider Demographics
NPI:1871547174
Name:MCCORMACK, MARY JO (DC)
Entity type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7819 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6146
Mailing Address - Country:US
Mailing Address - Phone:216-524-7313
Mailing Address - Fax:216-524-7312
Practice Address - Street 1:7819 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-6146
Practice Address - Country:US
Practice Address - Phone:216-524-7313
Practice Address - Fax:216-524-7312
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341877233OtherTAX ID
OH0687231Medicare ID - Type Unspecified