Provider Demographics
NPI:1487946315
Name:JACQUELINE A CORKIN DC
Entity type:Organization
Organization Name:JACQUELINE A CORKIN DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-283-8133
Mailing Address - Street 1:1101 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4737
Mailing Address - Country:US
Mailing Address - Phone:409-283-8133
Mailing Address - Fax:409-283-8134
Practice Address - Street 1:1101 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4737
Practice Address - Country:US
Practice Address - Phone:409-283-8133
Practice Address - Fax:409-283-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN