Provider Demographics
NPI:1235114232
Name:CORBETT, TARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:CORBETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 S NC HIGHWAY 119
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9738
Mailing Address - Country:US
Mailing Address - Phone:919-304-3788
Mailing Address - Fax:919-304-2589
Practice Address - Street 1:1252 S FIFTH ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9756
Practice Address - Country:US
Practice Address - Phone:919-304-3788
Practice Address - Fax:919-304-2589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009446111N00000X
NC3397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2458188Medicare ID - Type Unspecified