Provider Demographics
NPI:1083784870
Name:CORLEW, NORMAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:E
Last Name:CORLEW
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:PO BOX 10312
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-0312
Mailing Address - Country:US
Mailing Address - Phone:951-656-7724
Mailing Address - Fax:951-656-7724
Practice Address - Street 1:23890 ALESSANDRO BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-0312
Practice Address - Country:US
Practice Address - Phone:951-656-7724
Practice Address - Fax:951-656-3218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17455111N00000X
OR22943111N00000X
CA2240111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330290960OtherEIN
CADC0174550Medicare ID - Type Unspecified
CAU42563Medicare UPIN