Provider Demographics
NPI:1619064276
Name:CORVIN, CECIL TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:TODD
Last Name:CORVIN
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 1:375 HOSPITAL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2087
Mailing Address - Country:US
Mailing Address - Phone:336-753-0056
Mailing Address - Fax:336-753-0056
Practice Address - Street 1:375 HOSPITAL ST STE 100
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2087
Practice Address - Country:US
Practice Address - Phone:336-753-0056
Practice Address - Fax:336-753-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085TXOtherBLUE CROSS
NC2457152AMedicare ID - Type Unspecified
NC085TXOtherBLUE CROSS