Provider Demographics
NPI:1003827445
Name:CORNERSTONE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-698-0102
Mailing Address - Street 1:1415 GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792
Mailing Address - Country:US
Mailing Address - Phone:828-698-0102
Mailing Address - Fax:828-698-0639
Practice Address - Street 1:1415 GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792
Practice Address - Country:US
Practice Address - Phone:828-698-0102
Practice Address - Fax:828-698-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08834OtherNC STATE HEALTH PLAN
NC7908834Medicaid
NC08834OtherBC OF NC
NC08834OtherNC STATE HEALTH PLAN
NC08834OtherBC OF NC