Provider Demographics
NPI:1043249352
Name:PICHE, CORY J (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:J
Last Name:PICHE
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 1:120 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1116
Mailing Address - Country:US
Mailing Address - Phone:812-537-5616
Mailing Address - Fax:812-537-1804
Practice Address - Street 1:120 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1116
Practice Address - Country:US
Practice Address - Phone:812-537-5616
Practice Address - Fax:812-537-1804
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001885A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200248190AMedicaid
INU78259Medicare UPIN
IN151000EMedicare ID - Type Unspecified