Provider Demographics
NPI:1417354705
Name:CORNERSTONE CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-540-2560
Mailing Address - Street 1:204 CENTRAL EXPY S
Mailing Address - Street 2:SUITE 45
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 CENTRAL EXPY S
Practice Address - Street 2:SUITE 45
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2799
Practice Address - Country:US
Practice Address - Phone:214-383-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center