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General NPI Number Information
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NPI Number | 1477867166
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHIROPRACTOR CLINIC LLC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 504 N WASHINGTON ST
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City | SALEM
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State | MO
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Zip | 65560-1268
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Country | US
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Telephone | 573-729-5321
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Fax | 573-729-1010
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Provider Business Mailing Address
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Address Line | 504 N WASHINGTON ST
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City | SALEM
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State | MO
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Zip | 65560-1268
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Country | US
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Telephone | 573-729-5321
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Fax | 573-729-1010
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BERNARD DONALD SIROIS JR.
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Credential | D.C.
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Telephone | 573-729-5321
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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 | 005352
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 005551
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License Number State | MO
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