Provider Demographics
NPI:1568558278
Name:SERK, CORBY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CORBY
Middle Name:ROBERT
Last Name:SERK
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 1:7800 MARKET BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317
Mailing Address - Country:US
Mailing Address - Phone:952-934-4500
Mailing Address - Fax:952-934-4501
Practice Address - Street 1:7800 MARKET BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-934-4500
Practice Address - Fax:952-934-4500
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV05762Medicare UPIN
MN350003424Medicare ID - Type Unspecified