Healthcare Provider Details

I. General information

NPI: 1861406050
Provider Name (Legal Business Name): H. GLENN CORKINS D.C., PH.D., N.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6637 FOREST HILL BLVD
GREENACRES FL
33413-3354
US

IV. Provider business mailing address

PO BOX 542587
GREENACRES FL
33454-2587
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-4184
  • Fax: 561-433-1284
Mailing address:
  • Phone: 561-807-7763
  • Fax: 561-433-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7829
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH7829
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH7829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: