Provider Demographics
NPI:1437471505
Name:KALIS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KALIS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALIS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:313-382-5222
Mailing Address - Street 1:9833 REECK RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1356
Mailing Address - Country:US
Mailing Address - Phone:313-382-5222
Mailing Address - Fax:313-382-2348
Practice Address - Street 1:9833 REECK RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1356
Practice Address - Country:US
Practice Address - Phone:313-382-5222
Practice Address - Fax:313-382-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4962056Medicaid
MI4962056Medicaid
MI0M76150Medicare PIN