Provider Demographics
NPI:1134812878
Name:MIXON, CORBIN (DC)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:
Last Name:MIXON
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 1:681 N MONTEGO ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9183
Mailing Address - Country:US
Mailing Address - Phone:620-875-0769
Mailing Address - Fax:
Practice Address - Street 1:3952 S FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4604
Practice Address - Country:US
Practice Address - Phone:417-885-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023016890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor