Provider Demographics
NPI:1104144112
Name:CLISBY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:CLISBY CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLISBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:562-495-2121
Mailing Address - Street 1:100 W BROADWAY
Mailing Address - Street 2:STE. 1400
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4431
Mailing Address - Country:US
Mailing Address - Phone:562-495-2121
Mailing Address - Fax:562-495-3131
Practice Address - Street 1:100 W BROADWAY
Practice Address - Street 2:STE. 1400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4431
Practice Address - Country:US
Practice Address - Phone:562-495-2121
Practice Address - Fax:562-495-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty