Provider Demographics
NPI:1104526722
Name:TOBIN, CORISSA (DC)
Entity type:Individual
Prefix:
First Name:CORISSA
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PETALUMA BLVD N STE B9
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3051
Mailing Address - Country:US
Mailing Address - Phone:707-774-6035
Mailing Address - Fax:
Practice Address - Street 1:6 PETALUMA BLVD N STE B9
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3051
Practice Address - Country:US
Practice Address - Phone:707-774-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor