Provider Demographics
NPI:1164405205
Name:JAMES A CORSIGLIA DCPC
Entity Type:Organization
Organization Name:JAMES A CORSIGLIA DCPC
Other - Org Name:VILLAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CORSIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-322-1110
Mailing Address - Street 1:2224 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3961
Mailing Address - Country:US
Mailing Address - Phone:563-322-1110
Mailing Address - Fax:563-322-0017
Practice Address - Street 1:2224 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3961
Practice Address - Country:US
Practice Address - Phone:563-322-1110
Practice Address - Fax:563-322-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26949OtherBCBS PPO
IA26949OtherBCBS PPO
I12569Medicare UPIN