Provider Demographics
NPI:1700059649
Name:JAMES C CORZINE CORZINE CHIROPRACTIC OFFICE
Entity type:Organization
Organization Name:JAMES C CORZINE CORZINE CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:CORZINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-724-9200
Mailing Address - Street 1:210 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-1224
Mailing Address - Country:US
Mailing Address - Phone:618-724-9200
Mailing Address - Fax:
Practice Address - Street 1:210 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-1224
Practice Address - Country:US
Practice Address - Phone:618-724-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL288-2010OtherBLUE CROSS/BLUE SHIELD
IL713990Medicaid
IL713990Medicare PIN