Provider Demographics
NPI:1760553051
Name:KORB, LEWIS S (DC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:S
Last Name:KORB
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 1:540 BORDENTOWN AVE # 4200
Mailing Address - Street 2:P.O. BOX 157
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1544
Mailing Address - Country:US
Mailing Address - Phone:732-721-6789
Mailing Address - Fax:732-721-0433
Practice Address - Street 1:540 BORDENTOWN AVE # 4200
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1544
Practice Address - Country:US
Practice Address - Phone:732-721-6789
Practice Address - Fax:732-721-0433
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00433200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ765920TYXMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
NJU49132Medicare UPIN