Provider Demographics
NPI:1285857797
Name:CALLIS, MICHAEL CRAIG (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:CALLIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 W TUMBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8241
Mailing Address - Country:US
Mailing Address - Phone:208-353-1743
Mailing Address - Fax:208-895-8176
Practice Address - Street 1:2053 E FAIRVIEW AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8043
Practice Address - Country:US
Practice Address - Phone:208-353-1743
Practice Address - Fax:208-895-0978
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor