Provider Demographics
NPI:1184909145
Name:CORBIN, KYLE GARRETT (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:GARRETT
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 1:664 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3117
Mailing Address - Country:US
Mailing Address - Phone:508-336-4114
Mailing Address - Fax:508-557-0261
Practice Address - Street 1:664 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3117
Practice Address - Country:US
Practice Address - Phone:508-336-4114
Practice Address - Fax:508-557-0261
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10430111N00000X
MA3545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor