Provider Demographics
NPI:1396987426
Name:CORNERSTONE CHIROPRACTIC AND MASSAGE
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-327-7463
Mailing Address - Street 1:926 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2070
Mailing Address - Country:US
Mailing Address - Phone:517-327-7463
Mailing Address - Fax:517-886-5238
Practice Address - Street 1:926 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2070
Practice Address - Country:US
Practice Address - Phone:517-327-7463
Practice Address - Fax:517-886-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK007987305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM91140Medicare UPIN