Provider Demographics
NPI:1760812614
Name:WILHELMSEN, COREY MACK (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:MACK
Last Name:WILHELMSEN
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 1:1210 W INDIAN HILLS DR UNIT 25
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6377
Mailing Address - Country:US
Mailing Address - Phone:801-655-3289
Mailing Address - Fax:
Practice Address - Street 1:558 E RIVERSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7135
Practice Address - Country:US
Practice Address - Phone:801-655-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87270091202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor