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General NPI Number Information
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NPI Number | 1598947483
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Entity Type | Organization
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Legal Business Name | CORNWELL CLINIC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 285 S SANTA FE AVE
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City | EDMOND
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State | OK
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Zip | 73003-4767
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Country | US
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Telephone | 405-330-2400
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Fax | 405-330-6591
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Provider Business Mailing Address
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Address Line | 285 S SANTA FE AVE
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City | EDMOND
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State | OK
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Zip | 73003-4767
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Country | US
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Telephone | 405-330-2400
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Fax | 405-330-6591
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. RONDALL LEE CORNWELL
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Credential | D.C.
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Telephone | 405-330-2400
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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 | 3476
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License Number State | OK
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