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General NPI Number Information
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NPI Number | 1003147810
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Entity Type | Individual
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Provider Name | COREY EUGENE BACON
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Gender | Male
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Dates
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Enumeration Date | 01/18/2010
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 200 E CHISHOLM ST SUITE C
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City | ALPENA
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State | MI
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Zip | 49707-5800
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Country | US
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Telephone | 989-916-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 637 W WASHINGTON AVE
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City | ALPENA
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State | MI
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Zip | 49707-2775
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Country | US
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Telephone | 989-916-7243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | NCCAOM113675
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License Number State |
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