Provider Demographics
NPI:1275154759
Name:ROBECK, CODY BERNARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:BERNARD
Last Name:ROBECK
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0717
Mailing Address - Country:US
Mailing Address - Phone:763-295-4105
Mailing Address - Fax:763-295-9116
Practice Address - Street 1:211 HIGHWAY 25 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-9306
Practice Address - Country:US
Practice Address - Phone:763-295-4105
Practice Address - Fax:763-295-9116
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor