Provider Demographics
NPI:1801828991
Name:CORY, JAMES DEAN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DEAN
Last Name:CORY
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 1:909 LINWAY DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-2431
Mailing Address - Country:US
Mailing Address - Phone:574-534-4400
Mailing Address - Fax:574-534-5855
Practice Address - Street 1:909 LINWAY DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2431
Practice Address - Country:US
Practice Address - Phone:574-534-4400
Practice Address - Fax:574-534-5855
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIN08001650A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV00147Medicare UPIN
IN216370Medicare ID - Type Unspecified