Provider Demographics
NPI:1720029689
Name:CORK, DIRK CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:CHRISTIAN
Last Name:CORK
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 955
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-0955
Mailing Address - Country:US
Mailing Address - Phone:513-313-6520
Mailing Address - Fax:
Practice Address - Street 1:5190 BRADEN LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6646
Practice Address - Country:US
Practice Address - Phone:513-313-6520
Practice Address - Fax:513-586-0854
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI741111N00000X, 111N00000X
OH1727111N00000X
IN08002238A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor