Provider Demographics
NPI:1417127200
Name:CORNERSTONE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-532-3366
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-0792
Mailing Address - Country:US
Mailing Address - Phone:970-532-3366
Mailing Address - Fax:970-532-3444
Practice Address - Street 1:120 BUNYAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-1188
Practice Address - Country:US
Practice Address - Phone:970-532-3366
Practice Address - Fax:970-532-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty