Provider Demographics
NPI:1730245929
Name:FRIDLINE, CORRINA KAY (DC)
Entity type:Individual
Prefix:DR
First Name:CORRINA
Middle Name:KAY
Last Name:FRIDLINE
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 1:11225 S SAGINAW ST
Mailing Address - Street 2:15
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1285
Mailing Address - Country:US
Mailing Address - Phone:810-694-8031
Mailing Address - Fax:810-736-3122
Practice Address - Street 1:11225 S SAGINAW ST
Practice Address - Street 2:15
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1285
Practice Address - Country:US
Practice Address - Phone:810-694-8031
Practice Address - Fax:810-736-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICF007120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B550730OtherBCBS
MI604354OtherACN MCARE
MI132239OtherASHN
MI3239707Medicaid
MI0M06410Medicare ID - Type Unspecified
MI3239707Medicaid