Provider Demographics
NPI:1528011855
Name:PIKE, CORY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:ANDREW
Last Name:PIKE
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 1:20 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-6100
Mailing Address - Country:US
Mailing Address - Phone:802-879-3900
Mailing Address - Fax:802-879-3511
Practice Address - Street 1:20 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-879-3900
Practice Address - Fax:802-879-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012508Medicaid
VT1012508Medicaid
U93999Medicare UPIN