Provider Demographics
NPI:1588650709
Name:EMBERLAND, CORY L (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:L
Last Name:EMBERLAND
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 1:5143 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2040
Mailing Address - Country:US
Mailing Address - Phone:952-881-2800
Mailing Address - Fax:612-605-2788
Practice Address - Street 1:5143 W 98TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2040
Practice Address - Country:US
Practice Address - Phone:952-881-2800
Practice Address - Fax:612-605-2788
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116633600Medicaid
MN76D61BLOtherBLUE CROSS BLUE SHIELD
MNU77171Medicare UPIN
MN76D61BLOtherBLUE CROSS BLUE SHIELD