=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821573098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2018
-----------------------------------------------------
Last Update Date | 10/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13291 W MCDOWELL RD STE E4
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-218-6676
-----------------------------------------------------
Fax | 623-266-2879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13291 W MCDOWELL RD STE E4
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-218-6676
-----------------------------------------------------
Fax | 623-266-2879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FRANK B HATCH
-----------------------------------------------------
Credential | D.C., F.I.A.C.A.
-----------------------------------------------------
Telephone | 623-218-6676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------