Provider Demographics
NPI:1609217421
Name:COREY, SALLY (DO)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1399
Mailing Address - Country:US
Mailing Address - Phone:815-758-0000
Mailing Address - Fax:815-786-3603
Practice Address - Street 1:1310 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1399
Practice Address - Country:US
Practice Address - Phone:815-758-0000
Practice Address - Fax:815-786-3603
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 390200000X
GA72977207X00000X
IL036176025207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery