Provider Demographics
NPI:1336325976
Name:CARLISLE CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:CARLISLE CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GVIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-989-0097
Mailing Address - Street 1:204 S 1ST ST
Mailing Address - Street 2:BOX 133
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-7601
Mailing Address - Country:US
Mailing Address - Phone:515-989-0097
Mailing Address - Fax:
Practice Address - Street 1:204 S 1ST ST
Practice Address - Street 2:BOX 133
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-7601
Practice Address - Country:US
Practice Address - Phone:515-989-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI5386Medicare PIN