Provider Demographics
NPI:1710318142
Name:IDROGO, COREY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:DAVID
Last Name:IDROGO
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 1:4109 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2096
Mailing Address - Country:US
Mailing Address - Phone:423-315-1690
Mailing Address - Fax:423-777-7751
Practice Address - Street 1:4109 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-315-1690
Practice Address - Fax:423-777-5571
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2023-11-28
Deactivation Date:2023-11-14
Deactivation Code:
Reactivation Date:2023-11-28
Provider Licenses
StateLicense IDTaxonomies
IL038012545111N00000X
TN2852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor