Provider Demographics
NPI:1538250527
Name:PISK, GREGORY D (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:PISK
Suffix:
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 1:178 2ND AVE EN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-257-5011
Mailing Address - Fax:406-755-5750
Practice Address - Street 1:178 2ND AVE EN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-257-5011
Practice Address - Fax:406-755-5750
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000164101Medicaid
MT0163812Medicaid
MT000042280OtherBLUE CROSS
MT350052535OtherRAILROAD RETIREMENT MEDICARE
MT0162331Medicaid
MT0163812Medicaid
MT000042280OtherBLUE CROSS