Provider Demographics
NPI:1730409111
Name:CORNERSTONE CHIROPRACTIC SC
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BINSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-731-3255
Mailing Address - Street 1:2763 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5750
Mailing Address - Country:US
Mailing Address - Phone:920-731-3255
Mailing Address - Fax:920-731-3357
Practice Address - Street 1:2763 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5750
Practice Address - Country:US
Practice Address - Phone:920-731-3255
Practice Address - Fax:920-731-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4234012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty