MEDICARE: CARLISLE CHIROPRACTIC CLINIC, PC

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	A05327	IA

General Provider Information

NPI Number	:	1336325976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLISLE CHIROPRACTIC CLINIC, PC

Provider Business Mailing Address
First Line	:	204 S 1ST ST
Second Line	:	BOX 133
City	:	CARLISLE
State	:	IA
Zip	:	50047-7601
Country	:	US
Telephone Number	:	515-989-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 S 1ST ST
Second Line	:	BOX 133
City	:	CARLISLE
State	:	IA
Zip	:	50047-7601
Country	:	US
Telephone Number	:	515-989-0097
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MARK ANDREW GVIST
Credential	:	D.C.
Telephone Number	:	515-989-0097

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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