Provider Demographics
NPI:1144851353
Name:SELLERS, CORY (DC)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:SELLERS
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 1:306 RIVERBEND BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2308
Mailing Address - Country:US
Mailing Address - Phone:407-756-5550
Mailing Address - Fax:
Practice Address - Street 1:306 RIVERBEND BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2308
Practice Address - Country:US
Practice Address - Phone:407-756-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor