Provider Demographics
NPI:1336404953
Name:REVELS, KOREY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KOREY
Middle Name:LEE
Last Name:REVELS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5511 RAEFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2057
Mailing Address - Country:US
Mailing Address - Phone:910-487-1300
Mailing Address - Fax:910-487-0030
Practice Address - Street 1:5511 RAEFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2057
Practice Address - Country:US
Practice Address - Phone:910-487-1300
Practice Address - Fax:910-487-0030
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor