Provider Demographics
NPI:1093439788
Name:KORTIS, MAGDALENA (DC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:KORTIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 TWELVE OAKS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6972
Mailing Address - Country:US
Mailing Address - Phone:330-617-6863
Mailing Address - Fax:
Practice Address - Street 1:2252 TWELVE OAKS WAY STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6972
Practice Address - Country:US
Practice Address - Phone:330-617-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor