Provider Demographics
NPI:1457393043
Name:KORSEN, JAY S (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:KORSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 POINT JUDITH RD
Mailing Address - Street 2:31C
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882
Mailing Address - Country:US
Mailing Address - Phone:401-789-2000
Mailing Address - Fax:401-782-2916
Practice Address - Street 1:140 POINT JUDITH RD
Practice Address - Street 2:31C
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882
Practice Address - Country:US
Practice Address - Phone:401-789-2000
Practice Address - Fax:401-782-2916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51940Medicare UPIN