MEDICARE: DR. MITCHELL RAY CORWIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0900X	Internist Chiropractor	DC12144	CA

General Provider Information

NPI Number	:	1306900121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL RAY CORWIN D.C.

Provider Business Mailing Address
First Line	:	2914 DOMINGO AVE
Second Line	:	SUITE B
City	:	BERKELEY
State	:	CA
Zip	:	94705-2454
Country	:	US
Telephone Number	:	510-845-3246
Fax Number	:	925-962-9927

Provider Business Practice Location Address
First Line	:	2914 DOMINGO AVE
Second Line	:	SUITE B
City	:	BERKELEY
State	:	CA
Zip	:	94705-2454
Country	:	US
Telephone Number	:	510-845-3246
Fax Number	:	925-962-9927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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