Provider Demographics
NPI:1083034672
Name:CORNERSTONE CHIROPRACTIC OF GREELEY, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC OF GREELEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-352-9277
Mailing Address - Street 1:2525 W 16TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4951
Mailing Address - Country:US
Mailing Address - Phone:970-352-9277
Mailing Address - Fax:970-352-9428
Practice Address - Street 1:2525 W 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4951
Practice Address - Country:US
Practice Address - Phone:970-352-9277
Practice Address - Fax:970-352-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5144261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC504888Medicare PIN