Provider Demographics
NPI:1043445752
Name:CORKIN, MARK S (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:CORKIN
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 1:2517 ROUTE 35
Mailing Address - Street 2:BUILDING B, SUITE 201
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-303-4172
Mailing Address - Fax:
Practice Address - Street 1:2517 ROUTE 35 STE B101
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1905
Practice Address - Country:US
Practice Address - Phone:732-303-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011829-1111N00000X
NJ38MC00697200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor