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General NPI Number Information
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NPI Number | 1346114089
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Entity Type | Individual
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Provider Name | CORBIN JACKSON
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Gender | Male
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Dates
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Enumeration Date | 10/04/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 1000 N GREEN VALLEY PKWY STE 230
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City | HENDERSON
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State | NV
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Zip | 89074-6171
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Country | US
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Telephone | 702-843-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 SUNRIDGE HEIGHTS WAY UNIT 1213
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City | HENDERSON
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State | NV
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Zip | 89052-4680
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Country | US
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Telephone | 408-410-8288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B02067
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License Number State | NV
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