MEDICARE: CORBETT CHIROPRACTIC AND HEALTH ENHANCEMENT, PA

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	3149	MN

General Provider Information

NPI Number	:	1497951610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBETT CHIROPRACTIC AND HEALTH ENHANCEMENT, PA

Provider Business Mailing Address
First Line	:	1605 HERITAGE DR
Second Line	:	SUITE A
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-3265
Country	:	US
Telephone Number	:	507-645-8846
Fax Number	:	507-645-4145

Provider Business Practice Location Address
First Line	:	1605 HERITAGE DR
Second Line	:	SUITE A
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-3265
Country	:	US
Telephone Number	:	507-645-8846
Fax Number	:	507-645-4145

Authorized Official
Title or Position	:	CHIROPRACTOR OWNER
Name	:	DR. DANIEL CORBETT
Credential	:
Telephone Number	:	507-645-8846

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	11/10/2014

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