MEDICARE: DR. RONDALL CORNWELL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3476	OK

General Provider Information

NPI Number	:	1932259199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONDALL CORNWELL DC

Provider Business Mailing Address
First Line	:	788 N SANTA FE AVE STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-4300
Country	:	US
Telephone Number	:	405-330-2400
Fax Number	:	405-330-2401

Provider Business Practice Location Address
First Line	:	788 N SANTA FE AVE STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-4300
Country	:	US
Telephone Number	:	405-330-2400
Fax Number	:	405-330-2401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	03/24/2020

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Directions to “ DR. RONDALL CORNWELL DC” Practice Location

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