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General NPI Number Information
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NPI Number | 1962532762
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Entity Type | Organization
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Legal Business Name | DR J L MCCALLISTER
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 60 FENTON ST STE 4
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City | LIVERMORE
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State | CA
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Zip | 94550-4196
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Country | US
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Telephone | 925-449-4884
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Fax | 925-449-5596
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Provider Business Mailing Address
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Address Line | 60 FENTON ST STE 4
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City | LIVERMORE
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State | CA
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Zip | 94550-4196
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Country | US
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Telephone | 925-449-4884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIMMIE LEE MCCALLISTER
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Credential | DC
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Telephone | 925-449-4884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0514530
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License Number State | CA
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