Provider Demographics
NPI:1114111051
Name:DR. LEA A. CORNISH, P.C.
Entity Type:Organization
Organization Name:DR. LEA A. CORNISH, P.C.
Other - Org Name:CORNISH CHIROPRACTIC, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-385-6200
Mailing Address - Street 1:624 W VETERANS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2505
Mailing Address - Country:US
Mailing Address - Phone:630-385-6200
Mailing Address - Fax:630-385-8526
Practice Address - Street 1:624 W VETERANS PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2505
Practice Address - Country:US
Practice Address - Phone:630-385-6200
Practice Address - Fax:630-385-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02206815OtherBC/BS #
IL5162162OtherAETNA
IL1073680260OtherINDIVIDUAL NPI
IL=========OtherTAX ID #
IL02206815OtherBC/BS #