Organization
BRAIN RESTORATION CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN-RONEL CORBIER M.D. (OWNER)
(704) 541-9117
Entity
Organization
Contact information
Practice address
1040 EDGEWATER CORP PKWY, SUITE 106, INDIAN LAND, SC 29707-4514
(704) 541-9117
(704) 541-9137
Mailing address
1040 EDGEWATER CORP PKWY, SUITE 106, INDIAN LAND, SC 29707-4514
(704) 541-9117
(704) 541-9137
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
200601910
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5905648
—
NC
Enumeration date
04/09/2014
Last updated
08/05/2015
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