Healthcare Provider Details

I. General information

NPI: 1992059901
Provider Name (Legal Business Name): COREY MICHAEL VOLLINK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W BIZTOWN LOOP
HAYDEN ID
83835
US

IV. Provider business mailing address

2881 HENRY ST SUITE A
NORTON SHORES MI
49441-4891
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-3660
  • Fax: 208-762-3600
Mailing address:
  • Phone: 231-766-8072
  • Fax: 231-737-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1831
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: