Provider Demographics
NPI:1366883308
Name:KALIS, PEGGY ANN (DC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:KALIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 S UNION ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2287
Mailing Address - Country:US
Mailing Address - Phone:734-751-1621
Mailing Address - Fax:
Practice Address - Street 1:263 S UNION ST
Practice Address - Street 2:APT 1
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2287
Practice Address - Country:US
Practice Address - Phone:734-751-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010109111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography