1992059901 NPI number — DR. COREY MICHAEL VOLLINK D.C.

Table of content: DR. COREY MICHAEL VOLLINK D.C. (NPI 1992059901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992059901 NPI number — DR. COREY MICHAEL VOLLINK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLLINK
Provider First Name:
COREY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992059901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2881 HENRY ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NORTON SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-4891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-766-8072
Provider Business Mailing Address Fax Number:
231-737-9002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W BIZTOWN LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYDEN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-762-3660
Provider Business Practice Location Address Fax Number:
208-762-3600
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIA-1831 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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