Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 22943 | OR |
Y | 111N00000X | Chiropractor | DC17455 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2240 | CA |
NPI | 1083784870 |
---|---|
Provider Name | Dr. Norman E Corlew |
First Address | Moreno Valley, CA 92552-0312 |
Second Address | Moreno Valley, CA 92553-0312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 22/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42563 | (02) | CA |