Provider Demographics
NPI:1033168372
Name:FROGLEY, CORY M (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:M
Last Name:FROGLEY
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 1:458 N 500 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6948
Mailing Address - Country:US
Mailing Address - Phone:801-292-9355
Mailing Address - Fax:801-296-8050
Practice Address - Street 1:458 N 500 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6948
Practice Address - Country:US
Practice Address - Phone:801-292-9355
Practice Address - Fax:801-296-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4828483-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4828483120001Medicaid
UTU92442Medicare UPIN
UT000060092Medicare PIN
UT4828483120001Medicaid