Provider Demographics
NPI:1790542959
Name:GJC ENTERPRISES, INC
Entity Type:Organization
Organization Name:GJC ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-895-0977
Mailing Address - Street 1:2053 E FAIRVIEW AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8044
Mailing Address - Country:US
Mailing Address - Phone:208-895-0977
Mailing Address - Fax:
Practice Address - Street 1:2053 E FAIRVIEW AVE STE 107
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8044
Practice Address - Country:US
Practice Address - Phone:208-895-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center