Provider Demographics
NPI:1255362638
Name:CUMISKEY, JOHN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:CUMISKEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2175 FOOTHILL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2958
Mailing Address - Country:US
Mailing Address - Phone:909-593-1990
Mailing Address - Fax:909-593-6809
Practice Address - Street 1:2175 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2958
Practice Address - Country:US
Practice Address - Phone:909-593-1990
Practice Address - Fax:909-593-6809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17456OtherMEDICARE IDENTIFICATION #