Healthcare Provider Details

I. General information

NPI: 1063829307
Provider Name (Legal Business Name): PISK CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 EDGEWOOD PL
WHITEFISH MT
59937-2358
US

IV. Provider business mailing address

559 EDGEWOOD PL
WHITEFISH MT
59937-2358
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-8080
  • Fax: 406-862-2769
Mailing address:
  • Phone: 406-862-8080
  • Fax: 406-862-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2923
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2927
License Number StateMT

VIII. Authorized Official

Name: MR. GREGORY D PISK
Title or Position: PRESIDENT
Credential: D.C., C.C.S.P.
Phone: 406-257-5011