Provider Demographics
NPI:1083816250
Name:ACCIDENT & REHAB CLINIC AT CORNERSTONE
Entity Type:Organization
Organization Name:ACCIDENT & REHAB CLINIC AT CORNERSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-631-1800
Mailing Address - Street 1:2717 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8464
Mailing Address - Country:US
Mailing Address - Phone:956-631-1800
Mailing Address - Fax:956-631-7661
Practice Address - Street 1:2717 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8464
Practice Address - Country:US
Practice Address - Phone:956-631-1800
Practice Address - Fax:956-631-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC6462Medicare UPIN