=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205246154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE HEALTH AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2014
-----------------------------------------------------
Last Update Date | 04/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5509 COLLEYVILLE BLVD STE 100
-----------------------------------------------------
City | COLLEYVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76034-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-479-0055
-----------------------------------------------------
Fax | 817-479-0058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5509 COLLEYVILLE BLVD STE 100
-----------------------------------------------------
City | COLLEYVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76034-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-479-0055
-----------------------------------------------------
Fax | 817-479-0058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | STEVEN DOTSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 817-479-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------