Provider Demographics
NPI:1275823072
Name:CORNISH, CORNELL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:CORNELL
Middle Name:
Last Name:CORNISH
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E PLEASANT RUN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7401
Mailing Address - Country:US
Mailing Address - Phone:972-807-2310
Mailing Address - Fax:972-807-2318
Practice Address - Street 1:1120 E PLEASANT RUN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7401
Practice Address - Country:US
Practice Address - Phone:972-807-2310
Practice Address - Fax:972-807-2318
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor