Provider Demographics
NPI:1386717288
Name:CORLL, DAVID JAMES (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:CORLL
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 1:9375 SW COMMERCE CIR A-1
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9630
Mailing Address - Country:US
Mailing Address - Phone:503-585-9200
Mailing Address - Fax:503-582-1487
Practice Address - Street 1:9375 SW COMMERCE CIR A-1
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9630
Practice Address - Country:US
Practice Address - Phone:503-585-9200
Practice Address - Fax:503-582-1487
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006024Medicaid
ORU98938Medicare UPIN
OR006024Medicaid