Provider Demographics
NPI:1992147375
Name:KOREY KOTHMANN, D.C., PA
Entity type:Organization
Organization Name:KOREY KOTHMANN, D.C., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-791-3399
Mailing Address - Street 1:5407 4TH ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4379
Mailing Address - Country:US
Mailing Address - Phone:806-791-3399
Mailing Address - Fax:806-791-3934
Practice Address - Street 1:5407 4TH ST UNIT F
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4379
Practice Address - Country:US
Practice Address - Phone:806-791-3399
Practice Address - Fax:806-791-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty