Provider Demographics
NPI:1457349060
Name:CORNELL, JOSEPH ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:CORNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610A S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3129
Mailing Address - Country:US
Mailing Address - Phone:479-573-0300
Mailing Address - Fax:479-573-0302
Practice Address - Street 1:1610A S 46TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3129
Practice Address - Country:US
Practice Address - Phone:479-573-0300
Practice Address - Fax:479-573-0302
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU86155Medicare UPIN
AR5W498Medicare ID - Type Unspecified