Provider Demographics
NPI:1467420380
Name:CALISESI, JOHN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:CALISESI
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 1:1945 15TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7701
Mailing Address - Country:US
Mailing Address - Phone:515-955-2313
Mailing Address - Fax:
Practice Address - Street 1:24 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4964
Practice Address - Country:US
Practice Address - Phone:515-576-2183
Practice Address - Fax:515-576-2336
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA4401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0489245Medicaid
IA0098392Medicaid
IAT00734Medicare UPIN
IA0098392Medicaid
IAI17570Medicare ID - Type UnspecifiedINDIVIDUAL