Provider Demographics
NPI:1447381223
Name:SONDRUP, COREY JOE (DC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:JOE
Last Name:SONDRUP
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 1:1117 COUNTRY HILLS DR
Mailing Address - Street 2:STE.2
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2559
Mailing Address - Country:US
Mailing Address - Phone:801-476-1752
Mailing Address - Fax:801-476-3075
Practice Address - Street 1:1117 COUNTRY HILLS DR
Practice Address - Street 2:STE.2
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2559
Practice Address - Country:US
Practice Address - Phone:801-476-1752
Practice Address - Fax:801-476-3075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96317081-1202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU62190Medicare UPIN
UT005715101Medicare ID - Type Unspecified