Provider Demographics
NPI:1750633574
Name:MICHAEL E. CORRY, DC, PA
Entity Type:Organization
Organization Name:MICHAEL E. CORRY, DC, PA
Other - Org Name:RIVERBRIDGE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-968-0922
Mailing Address - Street 1:6858 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3352
Mailing Address - Country:US
Mailing Address - Phone:561-968-0922
Mailing Address - Fax:
Practice Address - Street 1:6858 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3352
Practice Address - Country:US
Practice Address - Phone:561-968-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380100400Medicaid
FL88840Medicare PIN
FL380100400Medicaid