Provider Demographics
NPI:1427047067
Name:GOULD, COREY D (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:D
Last Name:GOULD
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 1:30302 ANAMONTE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2362
Mailing Address - Country:US
Mailing Address - Phone:949-363-7407
Mailing Address - Fax:
Practice Address - Street 1:26072 MERIT CIR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7015
Practice Address - Country:US
Practice Address - Phone:949-859-6600
Practice Address - Fax:949-859-6606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC23822AMedicare ID - Type Unspecified