Healthcare Provider Details

I. General information

NPI: 1295759793
Provider Name (Legal Business Name): DAVID KIPLYN CORBIN D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 PERKINS RD SUITE 155
BATON ROUGE LA
70810-1078
US

IV. Provider business mailing address

PO BOX 82808
BATON ROUGE LA
70884-2808
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-3031
  • Fax: 225-767-0045
Mailing address:
  • Phone: 225-766-3031
  • Fax: 225-767-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number588
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: