Provider Demographics
NPI:1205029873
Name:DAVID K CORBIN DC LLC
Entity Type:Organization
Organization Name:DAVID K CORBIN DC LLC
Other - Org Name:CHIROPRACTIC SPORTS & INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLAIMS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-3031
Mailing Address - Street 1:PO BOX 82808
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-2808
Mailing Address - Country:US
Mailing Address - Phone:225-766-3031
Mailing Address - Fax:225-767-0045
Practice Address - Street 1:7731 PERKINS RD
Practice Address - Street 2:SUITE 155
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1078
Practice Address - Country:US
Practice Address - Phone:225-766-3031
Practice Address - Fax:225-767-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA588261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT20078Medicare UPIN