Provider Demographics
NPI:1952789224
Name:ST DENIS, CORY (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:ST DENIS
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 1:33 ROLLING RDG
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-7037
Mailing Address - Country:US
Mailing Address - Phone:207-619-3242
Mailing Address - Fax:
Practice Address - Street 1:33 ROLLING RDG
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-7037
Practice Address - Country:US
Practice Address - Phone:207-619-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor