Provider Demographics
NPI:1124808837
Name:CORMANY, ETHAN PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:PATRICK
Last Name:CORMANY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 FARM BANK WAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1974
Mailing Address - Country:US
Mailing Address - Phone:614-539-0405
Mailing Address - Fax:
Practice Address - Street 1:3435 FARM BANK WAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1974
Practice Address - Country:US
Practice Address - Phone:614-539-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor