Healthcare Provider Details

I. General information

NPI: 1871685727
Provider Name (Legal Business Name): VINCENT J CORCORAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S ORCHARD AVE
UKIAH CA
95482
US

IV. Provider business mailing address

680 S ORCHARD AVE
UKIAH CA
95482
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-1984
  • Fax: 707-463-1300
Mailing address:
  • Phone: 707-463-1984
  • Fax: 707-463-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0156740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: