MEDICARE: CORBIN CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008926	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B51344	OTHER	MI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1245425263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBIN CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	5092 W VIENNA RD
Second Line	:	SUITE H
City	:	CLIO
State	:	MI
Zip	:	48420-2803
Country	:	US
Telephone Number	:	810-686-3123
Fax Number	:	810-686-3124

Provider Business Practice Location Address
First Line	:	5092 W VIENNA RD
Second Line	:	SUITE H
City	:	CLIO
State	:	MI
Zip	:	48420-2803
Country	:	US
Telephone Number	:	810-686-3123
Fax Number	:	810-686-3124

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SUSAN LYNN CORBIN
Credential	:	D.C.
Telephone Number	:	810-686-3123

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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