Provider Demographics
NPI:1831447309
Name:CORLEY, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:CORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76703-0404
Mailing Address - Country:US
Mailing Address - Phone:806-438-6725
Mailing Address - Fax:806-438-6725
Practice Address - Street 1:3801 W WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7105
Practice Address - Country:US
Practice Address - Phone:806-438-6725
Practice Address - Fax:806-438-6725
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor