Provider Demographics
NPI:1245308360
Name:CORVIN CHIROPRACTIC, PC
Entity type:Organization
Organization Name:CORVIN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CORVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-753-0056
Mailing Address - Street 1:375 HOSPITAL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2086
Mailing Address - Country:US
Mailing Address - Phone:336-753-0056
Mailing Address - Fax:
Practice Address - Street 1:375 HOSPITAL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2086
Practice Address - Country:US
Practice Address - Phone:336-753-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085TXOtherBLUE CROSS
NC2457152AMedicare ID - Type Unspecified
NCU99988Medicare UPIN