Provider Demographics
NPI:1932676475
Name:KORNEGAY, HENRY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:MICHAEL
Last Name:KORNEGAY
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 1:8836 N HESS ST STE E
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8718
Mailing Address - Country:US
Mailing Address - Phone:208-758-9335
Mailing Address - Fax:208-758-9336
Practice Address - Street 1:8836 N HESS ST STE E
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8718
Practice Address - Country:US
Practice Address - Phone:208-758-9335
Practice Address - Fax:208-758-9336
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor