Provider Demographics
NPI:1801569983
Name:SHOUSE, CORY HEATH (DC)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:HEATH
Last Name:SHOUSE
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 1:2425 REGENCY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2948
Mailing Address - Country:US
Mailing Address - Phone:185-977-9121
Mailing Address - Fax:
Practice Address - Street 1:1103 SEATON AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1132
Practice Address - Country:US
Practice Address - Phone:606-618-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor