Provider Demographics
NPI:1366432346
Name:KINGSTON, CORY P (BS, DC)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:P
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 600 N
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9805
Mailing Address - Country:US
Mailing Address - Phone:435-755-6954
Mailing Address - Fax:
Practice Address - Street 1:981S MAIN ST 180
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6055
Practice Address - Country:US
Practice Address - Phone:435-752-5731
Practice Address - Fax:435-752-5736
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4737914-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor