Provider Demographics
NPI:1306900121
Name:CORWIN, MITCHELL RAY (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RAY
Last Name:CORWIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 DOMINGO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:510-845-3246
Mailing Address - Fax:925-962-9927
Practice Address - Street 1:2914 DOMINGO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2454
Practice Address - Country:US
Practice Address - Phone:510-845-3246
Practice Address - Fax:925-962-9927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12144111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12144Medicare ID - Type UnspecifiedLICENSE NUMBER