Healthcare Provider Details

I. General information

NPI: 1427365584
Provider Name (Legal Business Name): CORKIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STATE ST
SENECA FALLS NY
13148-1474
US

IV. Provider business mailing address

31 STATE ST
SENECA FALLS NY
13148-1474
US

V. Phone/Fax

Practice location:
  • Phone: 315-745-9166
  • Fax:
Mailing address:
  • Phone: 315-745-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011829-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberX011829-1
License Number StateNY

VIII. Authorized Official

Name: MARK S CORKIN
Title or Position: DBA OWNER/OPERATOR
Credential: D.C.
Phone: 315-745-9166