Provider Demographics
NPI:1962601534
Name:CORNERSTONE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-836-2225
Mailing Address - Street 1:301 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3603
Mailing Address - Country:US
Mailing Address - Phone:703-836-2225
Mailing Address - Fax:703-836-7172
Practice Address - Street 1:301 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3603
Practice Address - Country:US
Practice Address - Phone:703-836-2225
Practice Address - Fax:703-836-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-000996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA120851Medicare PIN