Provider Demographics
NPI:1144874140
Name:KORNE, COLTON DANIEL (DC)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:DANIEL
Last Name:KORNE
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 1:4861 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1610
Mailing Address - Country:US
Mailing Address - Phone:858-215-4485
Mailing Address - Fax:858-565-8504
Practice Address - Street 1:4861 CONVOY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1610
Practice Address - Country:US
Practice Address - Phone:858-215-4485
Practice Address - Fax:858-565-8504
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor