Provider Demographics
NPI:1245413145
Name:SERK FAMILY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:SERK FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBY
Authorized Official - Middle Name:
Authorized Official - Last Name:SERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-934-4500
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-0516
Mailing Address - Country:US
Mailing Address - Phone:952-934-4500
Mailing Address - Fax:953-934-4501
Practice Address - Street 1:7800 MARKET BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4610
Practice Address - Country:US
Practice Address - Phone:952-934-4500
Practice Address - Fax:952-934-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty