Provider Demographics
NPI:1487848719
Name:CORNERSTONE FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-209-9710
Mailing Address - Street 1:1590 THOMAS CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-5406
Mailing Address - Country:US
Mailing Address - Phone:651-209-9710
Mailing Address - Fax:651-209-9711
Practice Address - Street 1:1590 THOMAS CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5406
Practice Address - Country:US
Practice Address - Phone:651-209-9710
Practice Address - Fax:651-209-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05344Medicare PIN