MEDICARE: DR. H. GLENN CORKINS D.C., PH.D., N.M.D.

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	CH7829	FL
2	111NN1001X	Nutrition Chiropractor	CH7829	FL
3	111NR0200X	Radiology Chiropractor	CH7829	FL

General Provider Information

NPI Number	:	1861406050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. H. GLENN CORKINS D.C., PH.D., N.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 542587
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-2587
Country	:	US
Telephone Number	:	561-807-7763
Fax Number	:	561-433-1284

Provider Business Practice Location Address
First Line	:	6637 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3354
Country	:	US
Telephone Number	:	561-433-4184
Fax Number	:	561-433-1284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/19/2013

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