Provider Demographics
NPI:1477900579
Name:DOUBRAVA, CORY (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:DOUBRAVA
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 1:1136 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1258
Mailing Address - Country:US
Mailing Address - Phone:607-748-5145
Mailing Address - Fax:607-748-5140
Practice Address - Street 1:1136 FRONT ST
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1258
Practice Address - Country:US
Practice Address - Phone:607-748-5145
Practice Address - Fax:607-748-5140
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor