Healthcare Provider Details

I. General information

NPI: 1235206392
Provider Name (Legal Business Name): ROBERT J VORNBROCK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 QUADAY AVE NE 102
OTSEGO MN
55330-6651
US

IV. Provider business mailing address

9125 QUADAY AVE NE 102
OTSEGO MN
55330-6651
US

V. Phone/Fax

Practice location:
  • Phone: 763-274-0373
  • Fax: 763-274-0375
Mailing address:
  • Phone: 763-274-0373
  • Fax: 763-274-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2976
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: