Provider Demographics
NPI:1922065978
Name:GRINK, COREY J (DC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:J
Last Name:GRINK
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 1:2325 MARYLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1749
Mailing Address - Country:US
Mailing Address - Phone:215-657-9393
Mailing Address - Fax:215-657-9398
Practice Address - Street 1:2325 MARYLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1749
Practice Address - Country:US
Practice Address - Phone:215-657-9393
Practice Address - Fax:215-657-9398
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007659L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA811029OtherFIRST PRIORITY
PA0784811000OtherAMERIHEALTH
PA7310472OtherAETNA PPO/POS
PA1726279OtherAETNA HMO
PA1038611OtherASHN
PA7310472OtherAETNA PPO/POS
PA1726279OtherAETNA HMO