Provider Demographics
NPI:1851300396
Name:KALISEK, JEROME MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MICHAEL
Last Name:KALISEK
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 1:5061 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2018
Mailing Address - Country:US
Mailing Address - Phone:805-682-3003
Mailing Address - Fax:
Practice Address - Street 1:5061 8TH ST
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-2018
Practice Address - Country:US
Practice Address - Phone:805-682-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28896111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08678Medicare UPIN
CADC28896Medicare ID - Type UnspecifiedPROVIDER ID NUMBER