Provider Demographics
NPI:1639950025
Name:CORBIN, SCOTT ROGER (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROGER
Last Name:CORBIN
Suffix:
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6704
Mailing Address - Country:US
Mailing Address - Phone:707-853-2808
Mailing Address - Fax:707-562-4400
Practice Address - Street 1:608 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-6704
Practice Address - Country:US
Practice Address - Phone:707-853-2808
Practice Address - Fax:707-562-4400
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor