Healthcare Provider Details

I. General information

NPI: 1851560940
Provider Name (Legal Business Name): CORNERSTONE COMPLETE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MARKETPLACE DR SUITE 102
ROCKY MOUNT VA
24151-6516
US

IV. Provider business mailing address

45 MARKETPLACE DR SUITE 102
ROCKY MOUNT VA
24151-6516
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-3678
  • Fax: 540-483-3820
Mailing address:
  • Phone: 540-483-3678
  • Fax: 540-483-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0104000883
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101055266
License Number StateVA

VIII. Authorized Official

Name: MR. BRIAN T ROBBINS
Title or Position: OWNER
Credential: D.C.
Phone: 540-483-3678