Provider Demographics
NPI:1952380552
Name:SPEAR, KORY L (DC)
Entity Type:Individual
Prefix:MR
First Name:KORY
Middle Name:L
Last Name:SPEAR
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 1:7326 N. CHERRYVALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1059
Mailing Address - Country:US
Mailing Address - Phone:815-394-9805
Mailing Address - Fax:
Practice Address - Street 1:7326 N. CHERRYVALE DR.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1059
Practice Address - Country:US
Practice Address - Phone:815-394-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009737Medicaid
ILK52718Medicare UPIN