Healthcare Provider Details

I. General information

NPI: 1679205256
Provider Name (Legal Business Name): CORNERSTONE CHIROPRACTIC OF NEW FLORENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROACTIVE DR
NEW FLORENCE MO
63363-2515
US

IV. Provider business mailing address

1 PROACTIVE DR
NEW FLORENCE MO
63363-2515
US

V. Phone/Fax

Practice location:
  • Phone: 636-400-3213
  • Fax:
Mailing address:
  • Phone: 636-400-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ROACH
Title or Position: OWNER
Credential: DC
Phone: 636-333-9730