Provider Demographics
NPI:1124188271
Name:CORSI, JOHN P (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:CORSI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11129N WAUWATOSA RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3431
Mailing Address - Country:US
Mailing Address - Phone:414-354-5377
Mailing Address - Fax:414-354-0523
Practice Address - Street 1:11129N WAUWATOSA RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3431
Practice Address - Country:US
Practice Address - Phone:414-354-5377
Practice Address - Fax:414-354-0523
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3810-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38952400Medicaid
WI38952400Medicaid
WI000675098Medicare ID - Type UnspecifiedPROVIDER #