Healthcare Provider Details

I. General information

NPI: 1689892416
Provider Name (Legal Business Name): CORNERSTONE FAMILY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 HALIFAX RD SUITE E
SOUTH BOSTON VA
24592-4821
US

IV. Provider business mailing address

4019 HALIFAX RD SUITE E
SOUTH BOSTON VA
24592-4821
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-9210
  • Fax: 434-572-4272
Mailing address:
  • Phone: 434-572-9210
  • Fax: 434-572-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0104555720
License Number StateVA

VIII. Authorized Official

Name: MRS. PATTY S LAMBERTH
Title or Position: BILLING MANAGER
Credential:
Phone: 434-572-9210