Provider Demographics
NPI:1669450730
Name:CORBELLI, MARK ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:CORBELLI
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 1:1520 HUGUENOT RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2477
Mailing Address - Country:US
Mailing Address - Phone:804-897-0965
Mailing Address - Fax:
Practice Address - Street 1:1520 HUGUENOT RD
Practice Address - Street 2:SUITE 116
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2477
Practice Address - Country:US
Practice Address - Phone:804-897-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor