Provider Demographics
NPI:1447285333
Name:MCCALLISTER, ROBERT CY (LAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CY
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8680 GREENBACK LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-3969
Mailing Address - Country:US
Mailing Address - Phone:916-988-3379
Mailing Address - Fax:916-988-3324
Practice Address - Street 1:8680 GREENBACK LN
Practice Address - Street 2:SUITE 110
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-3969
Practice Address - Country:US
Practice Address - Phone:916-988-3379
Practice Address - Fax:916-988-3324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10242OtherCA ACUPUNCTURE LICENSE