Provider Demographics
NPI:1336691427
Name:CORNERSTONE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-355-3624
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-0842
Mailing Address - Country:US
Mailing Address - Phone:417-355-3624
Mailing Address - Fax:
Practice Address - Street 1:317 S WOOD ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1857
Practice Address - Country:US
Practice Address - Phone:417-451-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487006623OtherINDIVIDUAL NPI IDENTIFIER#
MO1336691427OtherGROUP NPI IDENTIFER#