Provider Demographics
NPI:1275676504
Name:CORBIN, JENNIFER L (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:CORBIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:25821 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7607
Mailing Address - Country:US
Mailing Address - Phone:253-854-1181
Mailing Address - Fax:253-850-9620
Practice Address - Street 1:25821 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7607
Practice Address - Country:US
Practice Address - Phone:253-854-1181
Practice Address - Fax:253-850-9620
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034670111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor