Provider Demographics
NPI:1194044669
Name:MICHAEL K COREY CHIROPRACTIC INC
Entity type:Organization
Organization Name:MICHAEL K COREY CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-730-5833
Mailing Address - Street 1:14471 CHAMBERS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6965
Mailing Address - Country:US
Mailing Address - Phone:714-730-5833
Mailing Address - Fax:714-730-5083
Practice Address - Street 1:14471 CHAMBERS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6965
Practice Address - Country:US
Practice Address - Phone:714-730-5833
Practice Address - Fax:714-730-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24946111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24946Medicare UPIN