Provider Demographics
NPI:1235153354
Name:CASEY, KORY (PA)
Entity Type:Individual
Prefix:DR
First Name:KORY
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E. HIBISCUS BLVD.
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-676-5600
Mailing Address - Fax:321-951-8162
Practice Address - Street 1:15 E HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3101
Practice Address - Country:US
Practice Address - Phone:321-676-5600
Practice Address - Fax:321-951-8162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380307400Medicaid
FLT55838Medicare UPIN
FL88465ZMedicare PIN