Provider Demographics
NPI:1952502106
Name:CORNERSTONE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:CORNERSTONE WELLNESS CENTER LLC
Other - Org Name:CORNERSTONE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SCHARNWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-443-7000
Mailing Address - Street 1:2722 BILLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-9767
Mailing Address - Country:US
Mailing Address - Phone:406-442-7000
Mailing Address - Fax:406-443-7007
Practice Address - Street 1:2722 BILLINGS AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9767
Practice Address - Country:US
Practice Address - Phone:406-443-7000
Practice Address - Fax:406-443-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011001323Medicare PIN