Provider Demographics
NPI:1093833329
Name:GLENN CORKINS DC PHD PA
Entity Type:Organization
Organization Name:GLENN CORKINS DC PHD PA
Other - Org Name:ADVANCED SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CORKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD, NMD
Authorized Official - Phone:561-433-4184
Mailing Address - Street 1:3015 S CONGRESS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2111
Mailing Address - Country:US
Mailing Address - Phone:561-433-4184
Mailing Address - Fax:561-433-1284
Practice Address - Street 1:3015 S CONGRESS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2111
Practice Address - Country:US
Practice Address - Phone:561-433-4184
Practice Address - Fax:561-433-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty