Provider Demographics
NPI:1699411132
Name:CTC-TRINITY GROVE
Entity type:Organization
Organization Name:CTC-TRINITY GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-807-2310
Mailing Address - Street 1:320 SINGLETON BLVD APT 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4117
Mailing Address - Country:US
Mailing Address - Phone:469-317-7860
Mailing Address - Fax:469-317-7860
Practice Address - Street 1:320 SINGLETON BLVD APT 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4117
Practice Address - Country:US
Practice Address - Phone:469-317-7860
Practice Address - Fax:469-317-7860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CTC CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-09
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty