Provider Demographics
NPI:1235206392
Name:VORNBROCK, ROBERT J (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:VORNBROCK
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 1:9125 QUADAY AVE NE
Mailing Address - Street 2:102
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6651
Mailing Address - Country:US
Mailing Address - Phone:763-274-0373
Mailing Address - Fax:763-274-0375
Practice Address - Street 1:9125 QUADAY AVE NE
Practice Address - Street 2:102
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6651
Practice Address - Country:US
Practice Address - Phone:763-274-0373
Practice Address - Fax:763-274-0375
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235206392Medicaid
MN1235206392Medicaid
MNU32366Medicare UPIN
MN237726800Medicaid
MN350003414Medicare ID - Type Unspecified