Provider Demographics
NPI:1730167321
Name:NOLL, CORY R (DC)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:R
Last Name:NOLL
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 1:3174 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6302
Mailing Address - Country:US
Mailing Address - Phone:828-669-5314
Mailing Address - Fax:828-669-2210
Practice Address - Street 1:3174 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6302
Practice Address - Country:US
Practice Address - Phone:828-669-5314
Practice Address - Fax:828-669-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085P0OtherBCBS
NC085P0OtherBCBS
NC2456960AMedicare ID - Type Unspecified