Provider Demographics
NPI:1699743823
Name:CORBIN, NATHAN R (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:CORBIN
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 1:3870 WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-8300
Mailing Address - Country:US
Mailing Address - Phone:773-209-0851
Mailing Address - Fax:
Practice Address - Street 1:207 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-7501
Practice Address - Country:US
Practice Address - Phone:585-889-3280
Practice Address - Fax:585-889-7759
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011197111N00000X
IL038011162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVO8487Medicare UPIN
NYBA0794Medicare ID - Type UnspecifiedKNIGHT CHIROPRACTIC LLP
NYRA9817Medicare ID - Type UnspecifiedNATHAN CORBIN