Provider Demographics
NPI:1922692938
Name:AGOSTO, KORYNNA ELIZE (DC)
Entity Type:Individual
Prefix:DR
First Name:KORYNNA
Middle Name:ELIZE
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 AIRLINE RD STE 280
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3480
Mailing Address - Country:US
Mailing Address - Phone:361-654-4747
Mailing Address - Fax:
Practice Address - Street 1:1220 AIRLINE RD STE 280
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3480
Practice Address - Country:US
Practice Address - Phone:361-654-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor