Provider Demographics
NPI:1457077109
Name:ESTREL, CODY TERRANCE (DC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:TERRANCE
Last Name:ESTREL
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 1:8820 OAK VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9480
Mailing Address - Country:US
Mailing Address - Phone:419-764-9509
Mailing Address - Fax:
Practice Address - Street 1:1012 STATE ROUTE 521
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8003
Practice Address - Country:US
Practice Address - Phone:740-363-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor