Provider Demographics
NPI:1689639551
Name:REZAC, CORY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:DAVID
Last Name:REZAC
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 1:606 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ARMSTRONG
Mailing Address - State:IA
Mailing Address - Zip Code:50514-7420
Mailing Address - Country:US
Mailing Address - Phone:712-868-4404
Mailing Address - Fax:712-864-3646
Practice Address - Street 1:606 2ND AVE
Practice Address - Street 2:
Practice Address - City:ARMSTRONG
Practice Address - State:IA
Practice Address - Zip Code:50514-7420
Practice Address - Country:US
Practice Address - Phone:712-868-4404
Practice Address - Fax:712-864-3646
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0262675Medicaid
IA0262675Medicaid