Provider Demographics
NPI:1811001795
Name:KISLING FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:KISLING FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:KISLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-946-2222
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007338261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811001795Medicaid