Healthcare Provider Details

I. General information

NPI: 1497708200
Provider Name (Legal Business Name): JOHN PISPIDIKIS NP-C, DC, DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 E 12 MILE RD
WARREN MI
48092-5644
US

IV. Provider business mailing address

2243 E 12 MILE RD
WARREN MI
48092-5644
US

V. Phone/Fax

Practice location:
  • Phone: 214-717-1859
  • Fax: 586-573-8100
Mailing address:
  • Phone: 214-717-1859
  • Fax: 586-573-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704287416
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC8263
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301009328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: