Provider Demographics
NPI:1073680260
Name:CORNISH, LEA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:ANN
Last Name:CORNISH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4388
Mailing Address - Country:US
Mailing Address - Phone:630-963-1410
Mailing Address - Fax:630-963-1456
Practice Address - Street 1:1025 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4388
Practice Address - Country:US
Practice Address - Phone:630-963-1410
Practice Address - Fax:630-963-1456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02206815OtherBLUE CROSS BLUE SHEILD
IL5162162OtherAETNA
IL02206815OtherBLUE CROSS BLUE SHEILD
IL5162162OtherAETNA