Healthcare Provider Details

I. General information

NPI: 1497009195
Provider Name (Legal Business Name): CORBIN CHIROPRACTIC S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S WALNUT ST
ROCHESTER IL
62563-7501
US

IV. Provider business mailing address

3870 WAGON TRL
SPRINGFIELD IL
62712-8300
US

V. Phone/Fax

Practice location:
  • Phone: 773-209-0851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: NATHAN CORBIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 773-209-0851