=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467085209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2020
-----------------------------------------------------
Last Update Date | 02/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505A W MARTINTOWN RD
-----------------------------------------------------
City | NORTH AUGUSTA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29841-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-240-0713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2136 BONNEVILLE CR.
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-240-0713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. GREG STONE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 803-240-0713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------