Provider Demographics
NPI:1841539194
Name:GIRDWOOD, COREY LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:LOUIS
Last Name:GIRDWOOD
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 1:18350 MURDOCK CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1024
Mailing Address - Country:US
Mailing Address - Phone:941-258-3550
Mailing Address - Fax:941-258-3551
Practice Address - Street 1:18350 MURDOCK CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1024
Practice Address - Country:US
Practice Address - Phone:941-258-3550
Practice Address - Fax:941-258-3551
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor