Provider Demographics
NPI:1699159277
Name:CORNERSTONE WELLNESS GROUP, LLC
Entity type:Organization
Organization Name:CORNERSTONE WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIESHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VON KAENEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-979-0342
Mailing Address - Street 1:5912 S CODY ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-9542
Mailing Address - Country:US
Mailing Address - Phone:303-979-0342
Mailing Address - Fax:
Practice Address - Street 1:5912 S CODY ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-9542
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20151373659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty