Provider Demographics
NPI:1952850547
Name:SZYBALA, CORY (ND)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:SZYBALA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 SE BELMONT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1676
Mailing Address - Country:US
Mailing Address - Phone:503-445-8114
Mailing Address - Fax:
Practice Address - Street 1:128 SADDLE ROAD
Practice Address - Street 2:SUITE 103 C
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-928-4022
Practice Address - Fax:208-908-0063
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2059175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath