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General NPI Number Information
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NPI Number | 1437187879
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Entity Type | Organization
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Legal Business Name | COBB CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 1001 N ELM STREET
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City | GREENSBORO
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State | NC
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Zip | 27401
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Country | US
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Telephone | 336-275-0836
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Fax | 336-275-5597
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Provider Business Mailing Address
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Address Line | 1001 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1423
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Country | US
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Telephone | 336-275-0836
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Fax | 336-275-5597
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN J CORSETTI
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Credential | DC
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Telephone | 336-275-0836
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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 | 4053
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License Number State | NC
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