Provider Demographics
NPI:1851560940
Name:CORNERSTONE COMPLETE CARE
Entity Type:Organization
Organization Name:CORNERSTONE COMPLETE CARE
Other - Org Name:CORECARE BACK INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-483-3678
Mailing Address - Street 1:45 MARKETPLACE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-6516
Mailing Address - Country:US
Mailing Address - Phone:540-483-3678
Mailing Address - Fax:540-483-3820
Practice Address - Street 1:45 MARKETPLACE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6516
Practice Address - Country:US
Practice Address - Phone:540-483-3678
Practice Address - Fax:540-483-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000883111NR0400X
VA0101055266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05545Medicare PIN