Provider Demographics
NPI:1710067798
Name:ACKER, CORY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:WAYNE
Last Name:ACKER
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 1:33669 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4730
Mailing Address - Country:US
Mailing Address - Phone:760-770-9133
Mailing Address - Fax:760-770-7383
Practice Address - Street 1:33669 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4730
Practice Address - Country:US
Practice Address - Phone:760-770-9133
Practice Address - Fax:760-770-7383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-0261740Medicare ID - Type Unspecified