Provider Demographics
NPI:1942393798
Name:CORNERSTONE CHIROPRACTIC & REHABILITATION CLINIC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC & REHABILITATION CLINIC
Other - Org Name:CORNERSTONE CHIROPRACTIC & REHABILITATION CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-544-3066
Mailing Address - Street 1:10850 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6103
Mailing Address - Country:US
Mailing Address - Phone:763-544-3066
Mailing Address - Fax:763-542-3950
Practice Address - Street 1:10850 COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6103
Practice Address - Country:US
Practice Address - Phone:763-544-3066
Practice Address - Fax:763-542-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN221G4COOtherBCBS GROUP #
MN822100600Medicaid
MN221G4COOtherBCBS GROUP #