Provider Demographics
NPI:1962532762
Name:DR J L MCCALLISTER
Entity type:Organization
Organization Name:DR J L MCCALLISTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-449-4884
Mailing Address - Street 1:60 FENTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4196
Mailing Address - Country:US
Mailing Address - Phone:925-449-4884
Mailing Address - Fax:
Practice Address - Street 1:60 FENTON ST STE 4
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4196
Practice Address - Country:US
Practice Address - Phone:925-449-4884
Practice Address - Fax:925-449-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0514530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0154532Medicare PIN