Provider Demographics
NPI:1407925944
Name:COROSANITE, JOSEPH JASON (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JASON
Last Name:COROSANITE
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 1:1183 PONTIAC TRAIL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390
Mailing Address - Country:US
Mailing Address - Phone:248-624-6111
Mailing Address - Fax:248-624-6129
Practice Address - Street 1:1183 PONTIAC TRAIL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390
Practice Address - Country:US
Practice Address - Phone:248-624-6111
Practice Address - Fax:248-624-6129
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF36387002Medicare PIN
MI0P01380Medicare ID - Type UnspecifiedMEDICARE GROUP #
MIU900701Medicare UPIN