Provider Demographics
NPI:1497926422
Name:CORL, DAVID LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:CORL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2659 W GUADALUPE RD
Mailing Address - Street 2:SUITE C 226
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7254
Mailing Address - Country:US
Mailing Address - Phone:480-820-2171
Mailing Address - Fax:480-345-9864
Practice Address - Street 1:2659 W GUADALUPE RD
Practice Address - Street 2:SUITE C 226
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7254
Practice Address - Country:US
Practice Address - Phone:480-820-2171
Practice Address - Fax:480-345-9864
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor