Provider Demographics
NPI: | 1245413145 |
---|---|
Name: | SERK FAMILY CHIROPRACTIC, PLLC |
Entity Type: | Organization |
Organization Name: | SERK FAMILY CHIROPRACTIC, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CORBY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SERK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 952-934-4500 |
Mailing Address - Street 1: | PO BOX 516 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHANHASSEN |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55317-0516 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-934-4500 |
Mailing Address - Fax: | 953-934-4501 |
Practice Address - Street 1: | 7800 MARKET BOULEVARD |
Practice Address - Street 2: | |
Practice Address - City: | CHANHASSEN |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55317-4610 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-934-4500 |
Practice Address - Fax: | 952-934-4501 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-13 |
Last Update Date: | 2011-11-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 4703 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |