Provider Demographics
NPI:1285857276
Name:PEDERSON, CORINNE MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:MARY
Last Name:PEDERSON
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 1:311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4292
Mailing Address - Country:US
Mailing Address - Phone:830-896-4108
Mailing Address - Fax:
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4292
Practice Address - Country:US
Practice Address - Phone:830-896-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor