Healthcare Provider Details

I. General information

NPI: 1124000120
Provider Name (Legal Business Name): CORY R DREES D.C., CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W SALEM AVE
INDIANOLA IA
50125-2421
US

IV. Provider business mailing address

1103 E IOWA AVE
INDIANOLA IA
50125-1513
US

V. Phone/Fax

Practice location:
  • Phone: 515-961-5202
  • Fax: 515-961-0998
Mailing address:
  • Phone: 515-961-5202
  • Fax: 515-961-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number06676
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: