Provider Demographics
NPI:1639249840
Name:ISLEY, KORY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:KORY
Middle Name:LEE
Last Name:ISLEY
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 1:1305 HISTORY CT NW
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2457
Mailing Address - Country:US
Mailing Address - Phone:507-364-7500
Mailing Address - Fax:507-364-7444
Practice Address - Street 1:317 1ST ST S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1603
Practice Address - Country:US
Practice Address - Phone:507-364-7500
Practice Address - Fax:507-364-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN028R4ISOtherBCBS
MN338682100Medicaid
MNU82827Medicare UPIN
MN350002248Medicare PIN