Provider Demographics
NPI:1699088815
Name:CORNERSTONE CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-343-2535
Mailing Address - Street 1:13470 N 83RD AVE, STE 302
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-773-0300
Mailing Address - Fax:623-773-0200
Practice Address - Street 1:13470 N 83RD AVE STE 302
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4150
Practice Address - Country:US
Practice Address - Phone:623-773-0300
Practice Address - Fax:623-773-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty