Provider Demographics
NPI:1215918628
Name:JOHN D CALISESI DC PC
Entity type:Organization
Organization Name:JOHN D CALISESI DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CALISESI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-576-2183
Mailing Address - Street 1:24 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4964
Mailing Address - Country:US
Mailing Address - Phone:515-576-2183
Mailing Address - Fax:515-576-2336
Practice Address - Street 1:24 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4964
Practice Address - Country:US
Practice Address - Phone:515-576-2183
Practice Address - Fax:515-576-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0098392Medicaid
IA0098392Medicaid
IAT00734Medicare UPIN