Provider Demographics
NPI:1417067364
Name:KORONET, DAVID E (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:KORONET
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 1:602 CENTER ST
Mailing Address - Street 2:#109
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7423
Mailing Address - Country:US
Mailing Address - Phone:301-829-1717
Mailing Address - Fax:301-829-5429
Practice Address - Street 1:602 CENTER ST
Practice Address - Street 2:#109
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7423
Practice Address - Country:US
Practice Address - Phone:301-829-1717
Practice Address - Fax:301-829-5429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1418111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM417Medicare PIN
MDT92826Medicare UPIN