Provider Demographics
NPI:1861645947
Name:CORNEILLER CHIROPRACTIC
Entity type:Organization
Organization Name:CORNEILLER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CORNEILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-831-8535
Mailing Address - Street 1:2811 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-831-8535
Mailing Address - Fax:715-831-8535
Practice Address - Street 1:2811 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6863
Practice Address - Country:US
Practice Address - Phone:715-831-8535
Practice Address - Fax:715-831-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3871-012251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38941300Medicaid
WI38941300Medicaid