Provider Demographics
NPI:1912069501
Name:CORNERSTONE CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC CENTER PC
Other - Org Name:KEITHLEY FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KEITHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-541-9150
Mailing Address - Street 1:715 KENSINGTON AVE STE 24A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5700
Mailing Address - Country:US
Mailing Address - Phone:406-541-9150
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINGTON AVE STE 24A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5700
Practice Address - Country:US
Practice Address - Phone:406-541-9150
Practice Address - Fax:406-541-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty