Provider Demographics
NPI:1619046992
Name:CORBIN, SHAY WESTON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:WESTON
Last Name:CORBIN
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:PO BOX 3321
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775
Mailing Address - Country:US
Mailing Address - Phone:225-635-4172
Mailing Address - Fax:225-635-4173
Practice Address - Street 1:12216 JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-635-4172
Practice Address - Fax:225-635-4173
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1275111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
10982048OtherCAQH
LAG2150OtherBLUECROSSBLUESHIELD
LAU89578Medicare UPIN
LA4C150Medicare ID - Type Unspecified