Provider Demographics
NPI:1447637541
Name:CORNERSTONE FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:CORNERSTONE FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-237-9477
Mailing Address - Street 1:2225 E STATE ROUTE 69
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5657
Mailing Address - Country:US
Mailing Address - Phone:928-237-9477
Mailing Address - Fax:
Practice Address - Street 1:2225 E STATE ROUTE 69
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5657
Practice Address - Country:US
Practice Address - Phone:928-237-9477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty