Provider Demographics
NPI:1124000120
Name:DREES, CORY R (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:R
Last Name:DREES
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1513
Mailing Address - Country:US
Mailing Address - Phone:515-961-5202
Mailing Address - Fax:515-961-0998
Practice Address - Street 1:214 W SALEM AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2421
Practice Address - Country:US
Practice Address - Phone:515-961-5202
Practice Address - Fax:515-961-0998
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06676111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11564Medicare ID - Type Unspecified