Healthcare Provider Details

I. General information

NPI: 1649286550
Provider Name (Legal Business Name): KOREY DEAN KOTHMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 4TH ST SUITE F
LUBBOCK TX
79416-4348
US

IV. Provider business mailing address

5407 4TH ST SUITE F
LUBBOCK TX
79416-4348
US

V. Phone/Fax

Practice location:
  • Phone: 806-791-3399
  • Fax: 806-791-3934
Mailing address:
  • Phone: 806-791-3399
  • Fax: 806-791-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 7865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: