Provider Demographics
NPI:1518089077
Name:PISK CHIROPRACTIC & PHYSIOTHERAPY PC
Entity Type:Organization
Organization Name:PISK CHIROPRACTIC & PHYSIOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PISK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:406-257-5011
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083234OtherPTAN
MT000083234OtherPTAN