Provider Demographics
NPI:1245411362
Name:CORNERSTONE CHIROPRACTIC INC PS
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ILYANKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-379-6301
Mailing Address - Street 1:2003 132ND ST SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-379-6301
Mailing Address - Fax:425-379-5761
Practice Address - Street 1:2003 132ND ST SE
Practice Address - Street 2:SUITE E
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-379-6301
Practice Address - Fax:425-379-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003256111N00000X
WACH00033614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty