Provider Demographics
NPI:1144246802
Name:WASICEK, COREY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ALLEN
Last Name:WASICEK
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-0468
Mailing Address - Country:US
Mailing Address - Phone:361-485-1318
Mailing Address - Fax:316-485-1327
Practice Address - Street 1:1501 E RED RIVER ST
Practice Address - Street 2:SUITE A2
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5522
Practice Address - Country:US
Practice Address - Phone:361-485-1318
Practice Address - Fax:361-485-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor