Healthcare Provider Details

I. General information

NPI: 1154855088
Provider Name (Legal Business Name): CORNERSTONE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 106
MESA AZ
85209-5005
US

IV. Provider business mailing address

7227 E BASELINE RD STE 106
MESA AZ
85209-5005
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-5777
  • Fax: 480-584-4046
Mailing address:
  • Phone: 480-832-5777
  • Fax: 480-584-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8621
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7723
License Number StateAZ

VIII. Authorized Official

Name: MR. CLAY WARREN
Title or Position: CEO
Credential: D.C.
Phone: 480-832-5777