Provider Demographics
NPI:1275777864
Name:SARTIN, CORY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:SARTIN
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 1:420W MAIN ST 206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7363
Mailing Address - Country:US
Mailing Address - Phone:208-426-9200
Mailing Address - Fax:
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7284
Practice Address - Country:US
Practice Address - Phone:208-426-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20007622Medicare UPIN