Provider Demographics
NPI:1346328689
Name:KISH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KISH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-437-3600
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:53572-1917
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:53572-1917
Practice Address - Country:US
Practice Address - Phone:608-437-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2070111N00000X
WI71236030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75322Medicaid
WI38794400Medicare ID - Type Unspecified