Healthcare Provider Details

I. General information

NPI: 1053406629
Provider Name (Legal Business Name): CORLIN ALDEN STEIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9161 WICKER AVENUE (US 41)
ST. JOHN IN
46373
US

IV. Provider business mailing address

9161 WICKER AVENUE (US 41) P.O. BOX 298
ST. JOHN IN
46373
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-4777
  • Fax: 219-365-0267
Mailing address:
  • Phone: 219-365-4777
  • Fax: 219-365-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001477
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: