Healthcare Provider Details

I. General information

NPI: 1285900530
Provider Name (Legal Business Name): CHRISTOPHER CORY CHEEK IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 BUSHY HILL DR UNIT B
SANTEE CA
92071-6348
US

IV. Provider business mailing address

P.O. BOX 357110 NAVAL AIR STATION NORTH ISLAND BLDG. 290
SAN DIEGO CA
92135
US

V. Phone/Fax

Practice location:
  • Phone: 702-277-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: