Provider Demographics
NPI:1114945763
Name:MCCALLISTER, JIMMIE (DC,QME)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:DC,QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 HOLMES ST.
Mailing Address - Street 2:BLDG D
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:925-449-4884
Mailing Address - Fax:925-449-5596
Practice Address - Street 1:1554 HOLMES ST
Practice Address - Street 2:BLDG D
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550
Practice Address - Country:US
Practice Address - Phone:925-449-4884
Practice Address - Fax:925-449-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0154530Medicare PIN