Provider Demographics
NPI:1780003889
Name:AMEELE, COREY (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:AMEELE
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:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:COPENHAGEN
Mailing Address - State:NY
Mailing Address - Zip Code:13626-0162
Mailing Address - Country:US
Mailing Address - Phone:585-694-0977
Mailing Address - Fax:
Practice Address - Street 1:101 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:COPENHAGEN
Practice Address - State:NY
Practice Address - Zip Code:13626-0162
Practice Address - Country:US
Practice Address - Phone:585-694-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012509-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor