Provider Demographics
NPI:1407090715
Name:CORBETT CHIROPRACTIC CARE, SC
Entity Type:Organization
Organization Name:CORBETT CHIROPRACTIC CARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L C
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-922-4980
Mailing Address - Street 1:520 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5726
Mailing Address - Country:US
Mailing Address - Phone:920-922-4980
Mailing Address - Fax:920-907-4329
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5726
Practice Address - Country:US
Practice Address - Phone:920-922-4980
Practice Address - Fax:920-907-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3673012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty