Healthcare Provider Details

I. General information

NPI: 1932290434
Provider Name (Legal Business Name): COREY S PIVA D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N STATE ROUTE 7
PLEASANT HILL MO
64080-9421
US

IV. Provider business mailing address

1805 NORTH STATE ROUTE 7
PLEASANT HILL MO
64080-1464
US

V. Phone/Fax

Practice location:
  • Phone: 816-540-8932
  • Fax: 816-540-8937
Mailing address:
  • Phone: 816-540-8932
  • Fax: 816-540-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2003026730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: