Provider Demographics
NPI:1437516648
Name:BRUMBAUGH, COREY
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:BRUMBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 W MARKET ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4202
Mailing Address - Country:US
Mailing Address - Phone:330-904-9890
Mailing Address - Fax:
Practice Address - Street 1:2640 W MARKET ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4202
Practice Address - Country:US
Practice Address - Phone:330-835-3005
Practice Address - Fax:330-835-3035
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor