Provider Demographics
NPI:1437187879
Name:COBB CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:COBB CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORSETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-275-0836
Mailing Address - Street 1:1001 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1423
Mailing Address - Country:US
Mailing Address - Phone:336-275-0836
Mailing Address - Fax:336-275-5597
Practice Address - Street 1:1001 N ELM STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-275-0836
Practice Address - Fax:336-275-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016CCOtherBCBS
NC016CCOtherBCBS
NC016CCOtherBCBS