Provider Demographics
NPI:1710295431
Name:CORNISH, CAROLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:CORNISH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 GRAHAM CIR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2717
Mailing Address - Country:US
Mailing Address - Phone:563-258-3229
Mailing Address - Fax:
Practice Address - Street 1:2276 GRAHAM CIR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2717
Practice Address - Country:US
Practice Address - Phone:563-258-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor