Provider Demographics
NPI:1538106141
Name:CORBIN, SUSAN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:CORBIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:BROEKHUIZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:418 KUULEI RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2716
Mailing Address - Country:US
Mailing Address - Phone:808-208-4511
Mailing Address - Fax:
Practice Address - Street 1:418 KUULEI RD
Practice Address - Street 2:SUITE G
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2716
Practice Address - Country:US
Practice Address - Phone:808-208-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008926111NR0200X
HIDC-1296111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor