=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639249840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KORY LEE ISLEY D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 1ST ST S
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56069-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-364-7500
-----------------------------------------------------
Fax | 507-364-7444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 HISTORY CT NW
-----------------------------------------------------
City | NEW PRAGUE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56071-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-364-7500
-----------------------------------------------------
Fax | 507-364-7444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3935
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------