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General NPI Number Information
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NPI Number | 1699088815
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 13470 N 83RD AVE STE 302
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City | PEORIA
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State | AZ
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Zip | 85381-4150
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Country | US
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Telephone | 623-773-0300
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Fax | 623-773-0200
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Provider Business Mailing Address
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Address Line | 13470 N 83RD AVE, STE 302
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City | PEORIA
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State | AZ
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Zip | 85381
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Country | US
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Telephone | 623-773-0300
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Fax | 623-773-0200
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA J HAUG
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Credential | DC
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Telephone | 218-343-2535
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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 | 8147
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License Number State | AZ
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