Provider Demographics
NPI:1972961209
Name:CORSTORPHINE, JAMES E (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:CORSTORPHINE
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 1:20440 SW PRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9701
Mailing Address - Country:US
Mailing Address - Phone:971-221-9182
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4351
Practice Address - Country:US
Practice Address - Phone:503-765-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor