Provider Demographics
NPI:1477234862
Name:DEIGHAN, CORY THOMAS (NBCHWC)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:THOMAS
Last Name:DEIGHAN
Suffix:
Gender:M
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 WINDY MIST WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2352
Mailing Address - Country:US
Mailing Address - Phone:412-715-4463
Mailing Address - Fax:
Practice Address - Street 1:11701 WINDY MIST WAY
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2352
Practice Address - Country:US
Practice Address - Phone:412-715-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3784362171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach