Provider Demographics
NPI:1568693380
Name:COREY A MOTE DC LLC
Entity Type:Organization
Organization Name:COREY A MOTE DC LLC
Other - Org Name:COREY A MOTE, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-754-3711
Mailing Address - Street 1:5332 HIGHWAY 115
Mailing Address - Street 2:STE B
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-6750
Mailing Address - Country:US
Mailing Address - Phone:706-754-3711
Mailing Address - Fax:706-754-3711
Practice Address - Street 1:5332 HIGHWAY 115
Practice Address - Street 2:STE B
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-6750
Practice Address - Country:US
Practice Address - Phone:706-754-3711
Practice Address - Fax:706-754-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty