Healthcare Provider Details

I. General information

NPI: 1154450278
Provider Name (Legal Business Name): NICHOLLE DIANE CORCORAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W BROADWAY
PLAINVIEW MN
55964-1255
US

IV. Provider business mailing address

323 W BROADWAY PO BOX 665
PLAINVIEW MN
55964-1255
US

V. Phone/Fax

Practice location:
  • Phone: 507-534-2600
  • Fax:
Mailing address:
  • Phone: 507-534-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4779
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: