MEDICARE: DR. THOMAS A. KISKA D.C., D.A.C.B.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0006291	FL

General Provider Information

NPI Number	:	1215097787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A. KISKA D.C., D.A.C.B.N.

Provider Business Mailing Address
First Line	:	440 3RD ST
Second Line	:	SUITE A
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-5111
Country	:	US
Telephone Number	:	904-249-5999
Fax Number	:	904-249-1768

Provider Business Practice Location Address
First Line	:	440 3RD ST
Second Line	:	SUITE A
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-5111
Country	:	US
Telephone Number	:	904-249-5999
Fax Number	:	904-249-1768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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