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NPI 1124000120

NPI 1124000120 : CORY R DREES D.C., CCSP : INDIANOLA, IA

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General NPI Number Information
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    NPI Number           |    1124000120
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    Entity Type          |    Individual 
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    Provider Name        |    CORY R DREES D.C., CCSP
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    11/16/2005
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    214 W SALEM AVE 
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    City                 |    INDIANOLA
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    State                |    IA
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    Zip                  |    50125-2421
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    Country              |    US
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    Telephone            |    515-961-5202
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    Fax                  |    515-961-0998
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Provider Business Mailing Address
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    Address Line         |    1103 E IOWA AVE 
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    City                 |    INDIANOLA
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    State                |    IA
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    Zip                  |    50125-1513
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    Country              |    US
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    Telephone            |    515-961-5202
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    Fax                  |    515-961-0998
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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        |    111NS0005X
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    Taxonomy Name        |    Sports Physician Chiropractor
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    License Number       |    06676
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    License Number State |    IA
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