Provider Demographics
NPI:1265595250
Name:MCCORMACK, LAUREN MICHELE (DC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELE
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 1:1317 W FOOTHILL BLVD
Mailing Address - Street 2:#115
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3676
Mailing Address - Country:US
Mailing Address - Phone:909-946-2267
Mailing Address - Fax:909-946-2252
Practice Address - Street 1:1317 W FOOTHILL BLVD
Practice Address - Street 2:#115
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3676
Practice Address - Country:US
Practice Address - Phone:909-946-2267
Practice Address - Fax:909-946-2252
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor