Provider Demographics
NPI:1407730559
Name:CODY, CHERISE (DC)
Entity type:Individual
Prefix:
First Name:CHERISE
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 VIA PRESA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9456
Mailing Address - Country:US
Mailing Address - Phone:760-646-7629
Mailing Address - Fax:
Practice Address - Street 1:6 VENTURE STE 115
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7347
Practice Address - Country:US
Practice Address - Phone:949-559-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor