Provider Demographics
NPI:1639318470
Name:CORBALEY, BENJAMIN CHEUK-MAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CHEUK-MAN
Last Name:CORBALEY
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 213
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0213
Mailing Address - Country:US
Mailing Address - Phone:817-721-9682
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6425
Practice Address - Country:US
Practice Address - Phone:817-721-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60075858111N00000X
TX11221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor