Healthcare Provider Details

I. General information

NPI: 1386744019
Provider Name (Legal Business Name): CORNELL CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BRIDGE ST
CORNELL WI
54732-8391
US

IV. Provider business mailing address

425 BRIDGE ST
CORNELL WI
54732-8391
US

V. Phone/Fax

Practice location:
  • Phone: 715-239-0909
  • Fax:
Mailing address:
  • Phone: 715-239-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4918
License Number StateCO

VIII. Authorized Official

Name: DR. GREOGORY JAMES SANCHEZ
Title or Position: OWNER
Credential: D.C.
Phone: 715-312-0405