Provider Demographics
NPI:1245425263
Name:CORBIN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CORBIN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-686-3123
Mailing Address - Street 1:5092 W VIENNA RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2803
Mailing Address - Country:US
Mailing Address - Phone:810-686-3123
Mailing Address - Fax:810-686-3124
Practice Address - Street 1:5092 W VIENNA RD
Practice Address - Street 2:SUITE H
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2803
Practice Address - Country:US
Practice Address - Phone:810-686-3123
Practice Address - Fax:810-686-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51344OtherBLUE CROSS/BLUE SHIELD
MI0P32810Medicare PIN