Provider Demographics
NPI:1063580785
Name:KALKSTEIN, JEFFREY WILLIAM (DC WITH PT PRIV)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:KALKSTEIN
Suffix:
Gender:M
Credentials:DC WITH PT PRIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5027
Mailing Address - Country:US
Mailing Address - Phone:410-296-7700
Mailing Address - Fax:410-296-7784
Practice Address - Street 1:26 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5027
Practice Address - Country:US
Practice Address - Phone:410-296-7700
Practice Address - Fax:410-296-7784
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01373111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM393Medicare PIN
MD1063580785Medicare PIN
MDT59569Medicare UPIN