Provider Demographics
NPI:1053406629
Name:STEIN, CORLIN ALDEN (DC)
Entity type:Individual
Prefix:MR
First Name:CORLIN
Middle Name:ALDEN
Last Name:STEIN
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 1:9161 WICKER AVENUE (US 41)
Mailing Address - Street 2:P.O. BOX 298
Mailing Address - City:ST. JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-4777
Mailing Address - Fax:219-365-0267
Practice Address - Street 1:9161 WICKER AVENUE (US 41)
Practice Address - Street 2:
Practice Address - City:ST. JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373
Practice Address - Country:US
Practice Address - Phone:219-365-4777
Practice Address - Fax:219-365-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000090043OtherBC/BS PROVIDER NUMBER
INP00092338OtherRAILROAD MEDICARE
000000090043OtherBC/BS PROVIDER NUMBER
IN406500Medicare ID - Type Unspecified