Provider Demographics
NPI:1972565059
Name:KISLING, ROBERT JEFFERSON (D C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEFFERSON
Last Name:KISLING
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6711
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-6711
Mailing Address - Country:US
Mailing Address - Phone:231-946-2222
Mailing Address - Fax:
Practice Address - Street 1:1323 CASS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4146
Practice Address - Country:US
Practice Address - Phone:231-946-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007338111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM 36090Medicare ID - Type Unspecified
C 65633Medicare UPIN