MEDICARE: CORBIN CHIROPRACTIC S.C.

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

General Provider Information

NPI Number	:	1497009195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBIN CHIROPRACTIC S.C.

Provider Business Mailing Address
First Line	:	3870 WAGON TRL
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-8300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 S WALNUT ST
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-7501
Country	:	US
Telephone Number	:	773-209-0851
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	NATHAN CORBIN
Credential	:	D.C.
Telephone Number	:	773-209-0851

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	11/01/2012

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