MEDICARE: CORNERSTONE CHIROPRACTIC CLINIC PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00034658	WA

General Provider Information

NPI Number	:	1164613980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE CHIROPRACTIC CLINIC PS

Provider Business Mailing Address
First Line	:	1903 GEORGE WASHINGTON WAY
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2307
Country	:	US
Telephone Number	:	509-942-1212
Fax Number	:	509-942-9155

Provider Business Practice Location Address
First Line	:	1903 GEORGE WASHINGTON WAY
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2307
Country	:	US
Telephone Number	:	509-942-1212
Fax Number	:	509-942-9155

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT CLIFTON WHITEMARSH
Credential	:	D.C.
Telephone Number	:	509-942-1212

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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