MEDICARE: CORNERSTONE CHIROPRACTIC LLC

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	0104-000996	VA

General Provider Information

NPI Number	:	1962601534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	301 S COLUMBUS ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3603
Country	:	US
Telephone Number	:	703-836-2225
Fax Number	:	703-836-7172

Provider Business Practice Location Address
First Line	:	301 S COLUMBUS ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3603
Country	:	US
Telephone Number	:	703-836-2225
Fax Number	:	703-836-7172

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. JULIA E WRAY
Credential	:	D.C.
Telephone Number	:	703-836-2225

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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