Provider Demographics
NPI:1376016576
Name:CORNERSTONE FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLDYCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-288-3633
Mailing Address - Street 1:6 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1118
Mailing Address - Country:US
Mailing Address - Phone:315-288-3633
Mailing Address - Fax:315-748-5372
Practice Address - Street 1:6 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1118
Practice Address - Country:US
Practice Address - Phone:315-288-3633
Practice Address - Fax:315-748-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty