Provider Demographics
NPI:1881883155
Name:CLISBY, KERRY LOUIS JR (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LOUIS
Last Name:CLISBY
Suffix:JR
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 1:100 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
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor