Provider Demographics
NPI:1871691972
Name:CROCHIERE, COREY RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:RICHARD
Last Name:CROCHIERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE J210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3904
Mailing Address - Country:US
Mailing Address - Phone:408-564-7820
Mailing Address - Fax:408-564-7848
Practice Address - Street 1:1101 S WINCHESTER BLVD STE J210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3904
Practice Address - Country:US
Practice Address - Phone:408-564-7820
Practice Address - Fax:408-564-7848
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor