1972043230 NPI number — CORNERSTONE PRIMARY CARE & CHIROPRACTIC, LLC

Table of content: (NPI 1972043230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972043230 NPI number — CORNERSTONE PRIMARY CARE & CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE PRIMARY CARE & CHIROPRACTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972043230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7227 E BASELINE RD
Provider Second Line Business Mailing Address:
STE 106
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85209-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-832-5777
Provider Business Mailing Address Fax Number:
480-584-4046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14843 N NORTHSIGHT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-315-8322
Provider Business Practice Location Address Fax Number:
480-410-6903
Provider Enumeration Date:
03/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTIC
Authorized Official Telephone Number:
480-365-9509

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7723 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 7618 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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