Provider Demographics
NPI:1679205256
Name:CORNERSTONE CHIROPRACTIC OF NEW FLORENCE LLC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC OF NEW FLORENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-333-9730
Mailing Address - Street 1:1 PROACTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW FLORENCE
Mailing Address - State:MO
Mailing Address - Zip Code:63363-2515
Mailing Address - Country:US
Mailing Address - Phone:636-400-3213
Mailing Address - Fax:
Practice Address - Street 1:1 PROACTIVE DR
Practice Address - Street 2:
Practice Address - City:NEW FLORENCE
Practice Address - State:MO
Practice Address - Zip Code:63363-2515
Practice Address - Country:US
Practice Address - Phone:636-400-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty