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General NPI Number Information
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NPI Number | 1548328552
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHIROPRACTIC INC.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 4013 PACIFIC AVE
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City | RIVERDALE
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State | UT
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Zip | 84405-1511
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Country | US
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Telephone | 801-394-9450
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Fax | 801-866-0033
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Provider Business Mailing Address
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Address Line | PO BOX 3243
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City | OGDEN
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State | UT
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Zip | 84409-1243
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Country | US
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Telephone | 801-394-9450
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Fax | 801-866-0033
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | TODD THOMAS DOXEY
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Credential | D.C.
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Telephone | 801-394-9450
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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 | 345031-1202
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License Number State | UT
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