Provider Demographics
NPI:1578700068
Name:DOUSHARM, COREY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:LYNN
Last Name:DOUSHARM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:LYNN
Other - Last Name:TIMPERLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4645 NORMAL BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-483-6633
Mailing Address - Fax:402-483-6919
Practice Address - Street 1:4645 NORMAL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5823
Practice Address - Country:US
Practice Address - Phone:402-483-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025715800Medicaid