Provider Demographics
NPI:1831781863
Name:JOHN, KORINNE L (DC, CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:KORINNE
Middle Name:L
Last Name:JOHN
Suffix:
Gender:F
Credentials:DC, CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W B ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1940
Mailing Address - Country:US
Mailing Address - Phone:307-532-5111
Mailing Address - Fax:
Practice Address - Street 1:2810 W B ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1940
Practice Address - Country:US
Practice Address - Phone:307-532-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor