Provider Demographics
NPI:1801386271
Name:CORNERSTONE INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:CORNERSTONE INTEGRATIVE HEALTH
Other - Org Name:JACOB J. SUH, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-475-9111
Mailing Address - Street 1:219 S MAIN ST APT 35
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2644
Mailing Address - Country:US
Mailing Address - Phone:813-507-1102
Mailing Address - Fax:
Practice Address - Street 1:5002 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3660
Practice Address - Country:US
Practice Address - Phone:630-475-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty