Provider Demographics
NPI:1649286550
Name:KOTHMANN, KOREY DEAN (DC)
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:DEAN
Last Name:KOTHMANN
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 1:5407 4TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4348
Mailing Address - Country:US
Mailing Address - Phone:806-791-3399
Mailing Address - Fax:806-791-3934
Practice Address - Street 1:5407 4TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4348
Practice Address - Country:US
Practice Address - Phone:806-791-3399
Practice Address - Fax:806-791-3934
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 7865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117066100OtherFIRSTCARE
TX609032OtherBLUE CROSS BLUE SHIELD
TX609032Medicare PIN
TX609032OtherBLUE CROSS BLUE SHIELD
TX117066100OtherFIRSTCARE