Provider Demographics
NPI:1235162538
Name:KISH, PETER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:KISH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:JOHN
Other - Last Name:KISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572
Mailing Address - Country:US
Mailing Address - Phone:608-437-3600
Mailing Address - Fax:
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572
Practice Address - Country:US
Practice Address - Phone:608-437-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2070111N00000X
WI71236030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38794400Medicaid
WI000075322Medicare PIN
WI75322Medicare ID - Type Unspecified