Provider Demographics
NPI:1104129386
Name:SW CORBIN ENTERPRISES LLC
Entity type:Organization
Organization Name:SW CORBIN ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-924-3989
Mailing Address - Street 1:7417 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8205
Mailing Address - Country:US
Mailing Address - Phone:225-924-3989
Mailing Address - Fax:225-924-3981
Practice Address - Street 1:7417 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8205
Practice Address - Country:US
Practice Address - Phone:225-924-3989
Practice Address - Fax:225-924-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty