Provider Demographics
NPI:1811065758
Name:CORSENTINO, JOSEPH LEE (DC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE
Last Name:CORSENTINO
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 1:3515 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9124
Mailing Address - Country:US
Mailing Address - Phone:970-506-1107
Mailing Address - Fax:
Practice Address - Street 1:2723 W 11TH STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5407
Practice Address - Country:US
Practice Address - Phone:970-346-8833
Practice Address - Fax:970-346-8833
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU32969Medicare UPIN
CO46033Medicare ID - Type Unspecified