Provider Demographics
NPI:1942479563
Name:CORLEY, JOHN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:CORLEY
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 1:106 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2515
Mailing Address - Country:US
Mailing Address - Phone:618-684-3344
Mailing Address - Fax:618-684-2216
Practice Address - Street 1:106 S 14TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2515
Practice Address - Country:US
Practice Address - Phone:618-684-3344
Practice Address - Fax:618-684-2216
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor