Provider Demographics
NPI:1811184336
Name:CORNERSTONE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CON
Authorized Official - Last Name:BYMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-762-2639
Mailing Address - Street 1:507 N NOKOMIS ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2352
Mailing Address - Country:US
Mailing Address - Phone:320-762-2639
Mailing Address - Fax:320-762-2650
Practice Address - Street 1:507 N NOKOMIS ST
Practice Address - Street 2:STE 202
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2352
Practice Address - Country:US
Practice Address - Phone:320-762-2639
Practice Address - Fax:320-762-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDD5201OtherRAILROAD MEDICARE
MN493R7C0OtherBLUECROSS BLUESHIELD
MN03072202OtherPRIMEWEST
MNC04044Medicare PIN