Provider Demographics
NPI:1366441974
Name:CORWIN, JAN MURRAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:MURRAY
Last Name:CORWIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 HAWTHORNE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3037
Mailing Address - Country:US
Mailing Address - Phone:510-654-8547
Mailing Address - Fax:510-654-9247
Practice Address - Street 1:494 HAWTHORNE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3037
Practice Address - Country:US
Practice Address - Phone:510-654-8547
Practice Address - Fax:510-654-9247
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11882111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04536Medicare UPIN
DC0118820Medicare ID - Type Unspecified