Healthcare Provider Details

I. General information

NPI: 1619046992
Provider Name (Legal Business Name): SHAY WESTON CORBIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12216 JACKSON ROAD
SAINT FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 3321
SAINT FRANCISVILLE LA
70775
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-4172
  • Fax: 225-635-4173
Mailing address:
  • Phone: 225-635-4172
  • Fax: 225-635-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1275
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: