=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194044669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL K COREY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2010
-----------------------------------------------------
Last Update Date | 05/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14471 CHAMBERS RD SUITE 105
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-6965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-730-5833
-----------------------------------------------------
Fax | 714-730-5083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14471 CHAMBERS RD SUITE 105
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-6965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-730-5833
-----------------------------------------------------
Fax | 714-730-5083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. MICHAEL K COREY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 714-730-5833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number | 24946
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------