Healthcare Provider Details

I. General information

NPI: 1588650709
Provider Name (Legal Business Name): CORY L EMBERLAND DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5143 W 98TH ST
BLOOMINGTON MN
55437-2040
US

IV. Provider business mailing address

5143 W 98TH ST
BLOOMINGTON MN
55437-2040
US

V. Phone/Fax

Practice location:
  • Phone: 952-881-2800
  • Fax: 612-605-2788
Mailing address:
  • Phone: 952-881-2800
  • Fax: 612-605-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: