Provider Demographics
NPI:1679713564
Name:OLDHAM, CORY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:MICHAEL
Last Name:OLDHAM
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 1:237 E MILLSAP RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6288
Mailing Address - Country:US
Mailing Address - Phone:479-287-4070
Mailing Address - Fax:479-287-4072
Practice Address - Street 1:237 E MILLSAP RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6288
Practice Address - Country:US
Practice Address - Phone:479-287-4070
Practice Address - Fax:479-287-4072
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor