Provider Demographics
NPI:1548217839
Name:CORCORAN, STEVEN THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THOMAS
Last Name:CORCORAN
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 1:1549 LAKELAND HILLS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-688-7238
Mailing Address - Fax:
Practice Address - Street 1:1549 LAKELAND HILLS BLVD
Practice Address - Street 2:STE B
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-688-7238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor