Healthcare Provider Details

I. General information

NPI: 1548328552
Provider Name (Legal Business Name): CORNERSTONE CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 PACIFIC AVE
RIVERDALE UT
84405-1511
US

IV. Provider business mailing address

PO BOX 3243
OGDEN UT
84409-1243
US

V. Phone/Fax

Practice location:
  • Phone: 801-394-9450
  • Fax: 801-866-0033
Mailing address:
  • Phone: 801-394-9450
  • Fax: 801-866-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number345031-1202
License Number StateUT

VIII. Authorized Official

Name: TODD THOMAS DOXEY
Title or Position: DIRECT OWNER
Credential: D.C.
Phone: 801-394-9450