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General NPI Number Information
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NPI Number | 1376889527
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Entity Type | Organization
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Legal Business Name | CORNERSTONE HEALTH CLINIC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 757 MALETA LN SUITE 102
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City | CASTLE ROCK
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State | CO
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Zip | 80108-7612
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Country | US
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Telephone | 720-524-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 757 MALETA LN SUITE 102
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City | CASTLE ROCK
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State | CO
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Zip | 80108-7612
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Country | US
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Telephone | 720-524-4267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRODERICK ALLEN SHEARD
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Credential | D.C.
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Telephone | 720-524-4267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0006904
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License Number State | CO
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