Provider Demographics
NPI:1467768820
Name:CORKIN CHIROPRACTIC
Entity Type:Organization
Organization Name:CORKIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DBA OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-745-9166
Mailing Address - Street 1:500 HELENDALE RD
Mailing Address - Street 2:STE. 260
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3173
Mailing Address - Country:US
Mailing Address - Phone:315-745-9166
Mailing Address - Fax:
Practice Address - Street 1:500 HELENDALE RD
Practice Address - Street 2:STE. 260
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:315-745-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011829-1111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty