Provider Demographics
NPI:1467800698
Name:PISK, ADAM G (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:G
Last Name:PISK
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 1:178 2ND AVENUE EAST N
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4103
Mailing Address - Country:US
Mailing Address - Phone:406-257-5011
Mailing Address - Fax:406-755-5750
Practice Address - Street 1:178 2ND AVENUE EAST N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4103
Practice Address - Country:US
Practice Address - Phone:406-257-5011
Practice Address - Fax:406-755-5750
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-4002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor