=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700059649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES C CORZINE CORZINE CHIROPRACTIC OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2008
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 W MARKET ST
-----------------------------------------------------
City | CHRISTOPHER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62822-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-724-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 W MARKET ST
-----------------------------------------------------
City | CHRISTOPHER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62822-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-724-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. JAMES CLAYTON CORZINE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 618-724-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------